Designing for the Embedding of Employee Voice

Previous research on employee voice has sought to design technological solutions that address the challenges of speaking up in the workplace. However, effectively embedding employee voice systems in organisations requires designers to engage with the social processes, power relations and contextual factors of individual workplaces. We explore this process within a university workplace through a research project responding to a crisis in educational service delivery arising from the COVID-19 pandemic. Within a successful three-month staff-led engagement, we examined the intricacies of embedding employee voice, exploring how the interactions between existing actors impacted the effectiveness of the process. We sought to identify specific actions to promote employee voice and overcome barriers to its successful establishment in organisational decision-making. We highlight design considerations for an effective employee voice system that facilitates embedding employee voice, including assurance, bounded accountability and bias reflexivity. © 2023 ACM.

Postacute COVID-19 Syndrome: 129Xe MRI Ventilation Defects and Respiratory Outcomes 1 Year Later.

Background In individuals with postacute COVID-19 syndrome (PACS) and normal pulmonary function, xenon 129 (129Xe) MRI ventilation defects, abnormal quality-of-life scores, and exercise limitation were reported 3 months after infection; the longitudinal trajectory remains unclear. Purpose To measure and compare pulmonary function, exercise capacity, quality of life, and 129Xe MRI ventilation defect percent (VDP) in individuals with PACS evaluated 3 and 15 months after COVID-19 infection. Materials and Methods In this prospective study, participants with PACS aged 18-80 years were enrolled between July 2020 and August 2021 from two quaternary care centers. 129Xe MRI VDP, diffusing capacity of lung for carbon monoxide (Dlco), spirometry, oscillometry, 6-minute walk distance (6MWD), and St George Respiratory Questionnaire (SGRQ) scores were evaluated 3 months and 15 months after COVID-19 infection. Differences between time points were evaluated using the paired t test. Multivariable models were generated to explain exercise capacity and quality-of-life improvement. Odds ratios (ORs) were used to evaluate potential treatment influences. Results Overall, 53 participants (mean age, 55 years ± 18 [SD]; 27 women) attended both 3- and 15-month visits and were included in the analysis. The mean values for 129Xe MRI VDP (5.8% and 4.2%; P = .003), forced expiratory volume in the 1st second of expiration percent predicted (84% and 90%; P = .001), Dlco percent predicted (86% and 99%; P = .002), and SGRQ score (35 and 25; P < .001) improved between the 3- and 15-month visit. VDP measured 3 months after COVID-19 infection predicted the change in 6MWD (ß = -0.643, P = .006), while treatment with respiratory medication at 3 months predicted an improved quality-of-life score at 15 months (OR, 4.0; 95% CI: 1.2, 13.8; P = .03). Conclusion Pulmonary function, gas exchange, exercise capacity, quality of life, and 129Xe MRI ventilation defect percent (VDP) improved in participants with postacute COVID-19 syndrome at 15 months compared with 3 months after infection. VDP measured at 3 months after infection correlated with improved exercise capacity, while treatment with respiratory medication was associated with an improved quality-of-life score 15 months after infection. ClinicalTrials.gov registration no. NCT05014516 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Vogel-Claussen in this issue.

Longitudinal follow-up of postacute COVID-19 syndrome: DLCO, quality-of-life and MRI pulmonary gas-exchange abnormalities.

129Xe MRI red blood cell to alveolar tissue plasma ratio (RBC:TP) abnormalities have been observed in ever-hospitalised and never-hospitalised people with postacute COVID-19 syndrome (PACS). But, it is not known if such abnormalities resolve when symptoms and quality-of-life scores improve. We evaluated 21 participants with PACS, 7±4 months (baseline) and 14±4 months (follow-up) postinfection. Significantly improved diffusing capacity of the lung for carbon monoxide (DLCO, Δ=14%pred ;95%CI 7 to 21, p<0.001), postexertional dyspnoea (Δ=-0.7; 95%CI=-0.2 to -1.2, p=0.019), St George's Respiratory Questionnaire-score (SGRQ Δ=-6; 95% CI=-1 to -11, p=0.044) but not RBC:TP (Δ=0.03; 95% CI=0.01 to 0.05, p=0.051) were observed at 14 months. DLCO correlated with RBC:TP (r=0.60, 95% CI=0.22 to 0.82, p=0.004) at 7 months. While DLCO and SGRQ measurements improved, these values did not normalise 14 months post-infection. ClinicalTrials.gov NCT04584671.

The impact of COVID-19 on prior and current learning

Purpose - The purpose of this paper is to measure the effects of COVID-19 on student learning. Using boundary theory and border theory, the authors hypothesize that learning will be highest in 2019, the year before the pandemic, and lowest in 2020, the year that the pandemic began. Design/methodology/approach - Participants were business students at an American university. The authors administered the same 88-question multiple-choice exam in a capstone course in May 2019, May 2020, and May 2021. Ten questions measured learning in the capstone course (current learning), and the remaining questions assessed learning from prerequisite courses (prior learning). Any year-to-year differences in test scores may be attributed to the effects of COVID-19. Findings - Current learning was exactly as hypothesized. It was highest in 2019 and lowest in 2020. Prior learning appeared to be completely unaffected by the pandemic. It increased slightly but insignificantly throughout the three years. The authors conclude that home-school boundary and border problems caused by the pandemic inhibited the ability of students to remember what they had recently learned but did not prevent them from demonstrating knowledge of information that they had acquired in pervious semesters. Originality/value - The authors add value to the body of knowledge about the effects of COVID-19 on student learning because (1) our dependent variable is cognitive. Most other studies have modeled attitudinal dependent variables such as satisfaction;and (2) this sample is located within the United States. Most other research has utilized participants in other countries and their results may not generalize to the American context.

One-Year Toxicity of Ultrahypofractionated Breast Radiotherapy (+/- Sequential Boost) and a Survey of Patient Experience

In March 2020, a 1-week hypofractionated adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions, was implemented to reduce the risk of COVID 19 virus for patients and staff without compromising on cancer outcomes. This prospective observational study aims to report late toxicities at 1-year and to confirm feasibility and acceptability of this new schedule for patients. – Patient reported outcome measures were recorded at baseline, 3 months, 6 months and 1 year following treatment completion. The presence of breast pain, swelling, hypersensitivity and skin problems, arm or shoulder pain, restricted arm movement and arm swelling were recorded using the EORTC QLQ BR45. Virtual teleconferencing without video was utilized at baseline, 3 months, 6 months and 1-year. Patients were invited to use video at the 1-year assessment for a physician-based assessment. To assess the experience of patients, a survey including 12 questions related to understanding, experiences of and benefits of ultrahypofractionated radiotherapy was developed and patients were invited to participate at the 1-year consultation. In total, 135 consecutive patients were enrolled Mar - Aug 2020. 121/135 (90%) patients completed the 1-year toxicity assessment and at least one other assessment. 30/121 (25%) patients received a sequential boost. The majority of patients reported no toxicity or a mild toxicity at all three time points, 76% (83/109) at 3 months, 76% (82/108) at 6 months, and 82% (99/121) at 1-year. At 1 year 17% (20/121) of patients reported a moderate toxicity, the most common being breast pain (6/121). 2% (2/121) of patients reported a marked toxicity, both reported multiple marked toxicities including appearance of breast, firmness and skin changes. For the 30 patients who received a boost a moderate toxicity was reported by 17% (5/30) at 1 year and 3% (1/30) reported a marked toxicity. There was one confirmed case of ipsilateral recurrence at 1-year. Only 30/121 patients were open to using video for the 1-year physician-based assessment. Regarding patient reported experience 90% (101/112) felt informed about the 1-week radiotherapy schedule, and 88% (99/112) felt informed about possible side effects and 94% (105/122) felt supported by the medical team throughout their treatment course. Only 49% (55/112) reported they would have been open to video consultations. Most patients undergoing ultrahypofractionated breast radiotherapy experience no toxicities or mild toxicities. These data suggest that adding a sequential boost following 26 Gy in 5 fractions to the whole breast is safe and does not lead to unacceptable 1-year toxicity. Patient satisfaction with ultrahypofractionated treatment and virtual consultations without video was high. However, less than half of patients may be open to virtual consultations and breast examination using video. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Persistent 129Xe MRI Pulmonary and CT Vascular Abnormalities in Symptomatic Individuals with Post-acute COVID-19 Syndrome.

BACKGROUND: In patients with post-acute COVID-19 syndrome (PACS), abnormal gas-transfer and pulmonary vascular density have been reported, but such findings have not been related to each other or to symptoms and exercise limitation. The pathophysiologic drivers of PACS in patients previously infected with COVID-19 who were admitted to in-patient treatment in hospital (or ever-hospitalized patients) and never-hospitalized patients are not well understood. PURPOSE: To determine the relationship of persistent symptoms and exercise limitation with xenon 129 (129Xe) MRI and CT pulmonary vascular measurements in individuals with PACS. MATERIALS AND METHODS: In this prospective study, patients with PACS aged 18-80 years with a positive polymerase chain reaction COVID-19 test were recruited from a quaternary-care COVID-19 clinic between April and October 2021. Participants with PACS underwent spirometry, diffusing capacity of the lung for carbon monoxide (DLco), 129Xe MRI, and chest CT. Healthy controls had no prior history of COVID-19 and underwent spirometry, DLco, and 129Xe MRI. The 129Xe MRI red blood cell (RBC) to alveolar-barrier signal ratio, RBC area under the receiver operating characteristic curve (AUC), CT volume of pulmonary vessels with cross-sectional area 5 mm2 or smaller (BV5), and total blood volume were quantified. St George's Respiratory Questionnaire, International Physical Activity Questionnaire, and modified Borg Dyspnea Scale measured quality of life, exercise limitation, and dyspnea. Differences between groups were compared with use of Welch t-tests or Welch analysis of variance. Relationships were evaluated with use of Pearson (r) and Spearman (ρ) correlations. RESULTS: Forty participants were evaluated, including six controls (mean age ± SD, 35 years ± 15, three women) and 34 participants with PACS (mean age, 53 years ± 13, 18 women), of whom 22 were never hospitalized. The 129Xe MRI RBC:barrier ratio was lower in ever-hospitalized participants (P = .04) compared to controls. BV5 correlated with RBC AUC (ρ = .44, P = .03). The 129Xe MRI RBC:barrier ratio was related to DLco (r = .57, P = .002) and forced expiratory volume in 1 second (ρ = .35, P = .03); RBC AUC was related to dyspnea (ρ = -.35, P = .04) and International Physical Activity Questionnaire score (ρ = .45, P = .02). CONCLUSION: Xenon 129 (129Xe) MRI measurements were lower in participants previously infected with COVID-19 who were admitted to in-patient treatment in hospital with post-acute COVID-19 syndrome, 34 weeks ± 25 after infection compared to controls. The 129Xe MRI measures were associated with CT pulmonary vascular density, diffusing capacity of the lung for carbon monoxide, exercise capacity, and dyspnea. Clinical trial registration no.: NCT04584671 © RSNA, 2022 Online supplemental material is available for this article See also the editorial by Wild and Collier in this issue.

129Xe MRI ventilation defects in ever-hospitalised and never-hospitalised people with post-acute COVID-19 syndrome.

BACKGROUND: Patients often report persistent symptoms beyond the acute infectious phase of COVID-19. Hyperpolarised 129Xe MRI provides a way to directly measure airway functional abnormalities; the clinical relevance of 129Xe MRI ventilation defects in ever-hospitalised and never-hospitalised patients who had COVID-19 has not been ascertained. It remains unclear if persistent symptoms beyond the infectious phase are related to small airways disease and ventilation heterogeneity. Hence, we measured 129Xe MRI ventilation defects, pulmonary function and symptoms in ever-hospitalised and never-hospitalised patients who had COVID-19 with persistent symptoms consistent with post-acute COVID-19 syndrome (PACS). METHODS: Consenting participants with a confirmed diagnosis of PACS completed 129Xe MRI, CT, spirometry, multi-breath inert-gas washout, 6-minute walk test, St. George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnoea scale, modified Borg scale and International Physical Activity Questionnaire. Consenting ever-COVID volunteers completed 129Xe MRI and pulmonary function tests only. RESULTS: Seventy-six post-COVID and nine never-COVID participants were evaluated. Ventilation defect per cent (VDP) was abnormal and significantly greater in ever-COVID as compared with never-COVID participants (p<0.001) and significantly greater in ever-hospitalised compared with never-hospitalised participants who had COVID-19 (p=0.048), in whom diffusing capacity of the lung for carbon-monoxide (p=0.009) and 6-minute walk distance (6MWD) (p=0.005) were also significantly different. 129Xe MRI VDP was also related to the 6MWD (p=0.02) and post-exertional SpO2 (p=0.002). Participants with abnormal VDP (≥4.3%) had significantly worse 6MWD (p=0.003) and post-exertional SpO2 (p=0.03). CONCLUSION: 129Xe MRI VDP was significantly worse in ever-hospitalised as compared with never-hospitalised participants and was related to 6MWD and exertional SpO2 but not SGRQ or mMRC scores. TRIAL REGISTRATION NUMBER: NCT05014516.

COVID-19 Post-lockdown: Perspectives, implications and strategies for disabled staff

The National Association of Disabled Staff Networks (NADSN) is a super-network that connects and represents disabled staff networks at organisations across the United Kingdom. NADSN has been very concerned about the development of national policy up to this time and for moving out of the COVID-19 lockdown stage as national policy has been silent in relation to disabled staff apart from in presenting a narrow, medicalised view. We have structured this paper within a social model of disability and the sentiments expressed in the UN Convention of the Rights of People with Disabilities (CRPD) in considering the current issues and setting out our 12 recommendations. This paper discusses NADSN's observations about the lived experiences of Disabled people during COVID-19. Secondly, it moves to outline COVID-19 and the changing workplace. The paper then moves to a broad discussion concerning safe working practices and policies as we move out of lockdown and beyond. (C) 2020 Association ALTER. Published by Elsevier Masson SAS. All rights reserved.

Pandemic Transition of an Established Hospital-Based Pulmonary Rehabilitation Program

Background: Pulmonary rehabilitation (PR) has demonstrated significant improvements in patients' exercise tolerance, quality of life, and mental health scores. These achievements have been obtained in traditional PR (t-PR) hospital-based, out-patient, in-person training programs. Recent evidence supports utilizing telehealth options to deliver standardized, rehabilitation programs to rural and remote communities without other access to PR. In March of 2020, an international pandemic was declared with regards to COVID-19. This forced t-PR programs to pause in-person patient contact, and consider dramatic changes to program delivery. Approach: We transformed our t-PR program into a completely full-fledged virtual PR (v-PR) programme that offered, via telephone and videoconferencing, education and exercise sessions. When it was deemed safe to resume inperson patient contact, specifically for PR exercise prescription determination, patients were brought in for exercise assessment only. This represented a complete transformation of our programme, and to our knowledge, was the first such offering in Ontario. Twice weekly regular video-based group exercise sessions, with a third being performed independently, was established while providing remote patients vital sign monitoring equipment throughout their enrollment to ensure safety. Education sessions were at first delivered by telephone, with the transitioning to video-lecturing by the end of 2020 occurring. Results: Enrollment data reveals the mean age for t-PR was 69.3 ± 9.2 years (n=164) compared to 69.9 ± 9.7 years for our v-PR (n=34). To date, completion data for six-minute walk distance (6MWD) improved in the t-PR (n=128) by 55.3 m (p < 0.001) and in the v-PR (n=8) 72.1 m (p < 0.001). General Anxiety Disorder-7 (GAD-7) questionnaire improved by 2 points in t-PR (n=129, p < 0.001) and by 3 points in the v-PR (n=8, p = 0.013). There was no change in the Patient Health Questionnaire (PHQ-9) score for the v-PR, whereas the t-PR had an improvement of 2 points (n=129, p < 0.001). COPD Assessment Test (CAT) scores in t-PR (n=130) improved by 4 points (p<0.001) and by 3 points (n=8, p= 0.013) in v-PR group. Discussion: Our current PR programme has demonstrated an important pivot during the current pandemic to provide a virtual curriculum. Preliminary data show that participants in v-PR improved significantly in their 6MWD, quality of life, and anxiety scores. This shift to the virtual option has allowed for continued care, despite the pandemic restrictions;and can be provided to other patients who otherwise would be unable to participate due to geographical restrictions.

Post-lockdown position paper

The National Association of Disabled Staff Networks (NADSN) is a super-network that connects and represents disabled staff networks at organisations across the United Kingdom. NADSN has been very concerned about the development of national policy up to this time and for moving out of the COVID-19 lockdown stage as national policy has been silent in relation to disabled staff apart from in presenting a narrow, medicalised view. We have structured this paper within a social model of disability and the sentiments expressed in the UN Convention of the Rights of People with Disabilities (CRPD) in considering the current issues and setting out our 12 recommendations. This paper discusses NADSN's observations about the lived experiences of Disabled people during COVID-19. Secondly, it moves to outline COVID-19 and the changing workplace. The paper then moves to a broad discussion concerning safe working practices and policies as we move out of lockdown and beyond. © 2020 Association ALTER

Holding onto the ‘mystery’ within online family and systemic therapy

Covid-19 has led to a shift towards online therapy. This paper focuses on therapists’ experiences of translating systemic practice online with families. A range of UK services are represented, including community, inpatient, adult and children services. A social construction theory, coordinated management of meaning, is used to understand online family and systemic therapy. The new context of online therapy influenced all other levels of the therapeutic encounter including content and structure of sessions, therapeutic relationship, therapists’ identity and culture of therapy. The relationship between ‘doing’ online therapy and reflecting on practice has been central in co-constructing new ways of interacting. There were many similarities across services, where there were differences these were client and context specific. As better ways of engaging emerged, therapists became more confident, creativity in therapy increased and attitudes about online therapy became more positive. Practitioner points: Online systemic therapy is possible across adult and children services at different tiers within community and inpatient settings. CMM provides a framework to understand communication in online therapy. Online therapy requires reconsiderations at all levels of the therapeutic encounter. Increased confidence and competence correlates with positive attitudes about online therapy. Online therapy is impacting on the overall evolving culture of therapy. © 2021 The Association for Family Therapy and Systemic Practice