Nursing a Radical Imagination: Moving from Theory and History to Action and Alternate Futures

Examining the historical context of healthcare whilst focusing on building a more just, equitable world, this book proposes a radical imagination for nursing and presents possibilities for speculative futures embracing queer, feminist, posthuman, and abolitionist frames. Bringing together radical and emancipatory perspectives from an international selection of authors, this book reflects on the realities created by the COVID-19 pandemic, recognizing that our situation is not new but the result of ongoing hegemonies and injustices. The authors attend to the history of nursing and related institutions, examining the assumptions, ideologies, and discourses that shape the discipline and its place within healthcare. They explore the impact of this context on contemporary nursing and look at alternative visions for the future. The final section specifically focuses on ways that we can move forward. Envisioning new possibilities for nursing, this innovative volume is a vital resource for practitioners, scholars and students keen to promote social justice within and without nursing. It is an important contribution to nursing theory, philosophy and history. © Jess Dillard-Wright, Jane Hopkins-Walsh, and Brandon Brown 2023 selection and editorial matter, individual chapters, the contributors.

Rates of Inpatient Hospitalization for Acute Pancreatitis in Patients <=21-Years-Old during the Covid-19 Pandemic

Background: Multiple studies to date in both pediatric and adult literature have suggested a possible link between acute pancreatitis and recent COVID-19 infection. There have also been several case reports in the pediatric population describing children who presented with acute pancreatitis found to be SARS-CoV-2 PCR positive. Objective(s): The primary aim of our study was to observe acute pancreatitis admission trends in patients <=21-years-old at a local children's hospital between March 1, 2016 and February 28, 2021. The secondary aim was to observe the relationship between COVID-19 and pancreatitis since the onset of the COVID-19 pandemic. We hypothesized that there is an increase in acute pancreatitis admissions in patients <=21 years since the onset of the COVID-19 pandemic, which may be best explained as a post-viral sequela of a recent COVID-19 infection. Method(s): This study is a retrospective chart review that consisted of the following inclusion criteria: any individuals hospitalized <=21 years of age at time of admission with the diagnosis of acute pancreatitis and a peak lipase >200 u/L. Additional data was also obtained including date of admission, duration of admission, peak lipase, etiology of acute pancreatitis, and SARS-CoV-2 IgG and PCR status. Result(s): Over the course of 5 years, 91 patients met the inclusion criteria across 116 admissions for acute pancreatitis. The average number of admissions per year was 23 with highest during year 5 with 39. Females were affected highest with a rate of 1.6:1. The most common etiology of the 116 admissions for acute pancreatitis was idiopathic which accounted for 50 admissions, followed by gallstone pancreatitis which accounted for 23 admissions. Of the 39 patients admitted during the first year of the pandemic, only one was SARS-CoV-2 positive and 2 were SARS-CoV-2 IgG positive;23 had PCR testing obtained and only 9 had IgG testing obtained. Conclusion(s): From the data obtained, there is a statistically significant increase in total admissions for acute pancreatitis during the first year of the pandemic (39 admissions). With a large number of confounding variables, it cannot be concluded this is the result of a current or recent COVID-19 infection. The largest confounding variables include lack of testing for SARS-CoV-2 PCR or IgG and multiple readmissions for acute pancreatitis during the first year of the pandemic compared to any of the previous years. Future investigations should be made to standardize COVID PCR and SARS-CoV2 IgG testing for all patients admitted with acute pancreatitis if further data collection is to be obtained.

Building provincial capacity for sustainable agricultural mechanisation in Nepal

This project was originally envisaged as an 18-month development-oriented project based in Provinces 1 and 2 of the Nepal Terai. It aimed to build solidarity and teamwork around the drive for agri-mechanisation in each of these two provincial governments. Unfortunately, the short time frame paired with intensive efforts to establish new relationships and then the onset of COVID-19 meant that there was limited scope to deeply develop these new relationships and fully build the envisaged roadmap process and plans. Regardless of this, the project has made some essential steps in improving provincial agri-mechanisation planning and implementation, including: (1) substantial capacity developed though placement of engineering experts within the Nepal Agricultural Research Council (NARC), the Ministries of Agriculture, Land Management and Cooperatives (MoLMAC), various cooperatives and agricultural knowledge centres;(2) new and deepened relationships with and between key stakeholders, and particularly between NARC and provincial government, as well as with and between various cooperatives;(3) development of the first quantification of the status of agri-mechanisation on the Nepal Terai - indicating that there is high potential for rapid mechanisation if some key constraints are addressed;(4) publication of the learnings for a review of mechanisation in India and Bangladesh, and what that means for Nepal's agri-mechanisation planning;(5) regional learnings and new collaborations with various stakeholders in Nepal and West Bengal;(6) a national symposium on agri-mechanisation on the Nepal Terai, with a large number of supported individuals attending and learning from the national Agrimechanisation Fair;(7) development of a "roadmap" process that can be used more widely with additional further development;and (8) technical guidance and relationship building to improve the scaling of government supported custom hire centres in Province 1.

HazeL: A Low-Cost Learning Platform for Aerosol Measurements

The switch to online instruction during the COVID-19 pandemic forced educators to adapt hands-on environmental engineering experiments to a remote curriculum previously conducted in a laboratory using expensive analytical instruments (> $2000 per device). Here, we describe how we developed a low-cost (<$200) aerosol sensor platform as a successful solution for supporting remote laboratories on air quality for environmental engineering courses in Spring 2021, and continued for in-person classes in Spring 2022. This sensor platform, called HazeL (Haze Laser Sensor), consists of an externally mounted aerosol sensor, a GPS receiver, and temperature and pressure sensors coupled to an Arduino MKR WiFi 1010 microcontroller connected via a Grove system. Using a project-based learning approach and implementing the scientific method, students worked asynchronously to design experiments, collect aerosol measurements, and analyze and visualize data using the R programming language. Students generated hypotheses regarding factors affecting air pollution, measured >= 0.3 mu m particles in different locations, tested differences between samples, and rejected the null hypothesis if appropriate. HazeL was also used for projects on data processing and statistical inference in an upper-level computational course. We present an instructional guide on manufacturing the HazeL platform and using it as a teaching tool for enhancing student experiential learning, participation, and engagement.

College students in China during initial COVID-19 pandemic: Role of social media on attitudes toward preventive measures.

Objective: To examine the direct and indirect associations (through risk perceptions) between college students' social media use and their perceived importance of COVID-19 preventive measures. Participants and Method: 1,353 undergraduate students in China completed an online survey in 2020 Spring. Results: Participants reported high reliance on social media for COVID-19 updates, which was positively associated with perceived importance of preventive measures. Information-oriented social media use was associated with higher perceived importance of preventive measures not only directly but also indirectly via increased cognitive and emotional risk perceptions. Social-oriented media use, on the other hand, had a negative direct association with perceived importance of preventive measure as well as a positive indirect association via emotional risk perception. Conclusions: This study shows that social media are important information sources for college students during the early stage of the pandemic and their response to the pandemic was related to social media use.

INTRODUCING AN EVIDENCE-BASED MINDFULNESS CURRICULUM IN A PEDIATRIC RESIDENCY PROGRAM - LESSONS FROM A PILOT STUDY

Purpose of Study Burnout is experienced by over 60% of physicians in the US with a 10% increase in the past year, and leads to degradation of patient care, low professional satisfaction, increased physician turnover, and increased healthcare costs. The COVID-19 pandemic has magnified and exacerbated these challenges. Pediatric mental impact from this healthcare crisis has been referred to as the second pandemic, and dealing with it requires health professionals to be centered and resilient. Physicians experiencing burnout can suffer from denial at first, preventing early intervention. One proposed solution is incorporating mindfulness-based meditation into the residency wellness curriculum. This study compared a pilot study in 2019 with a subsequent study in 2021 incorporating changes reflecting lessons learned from the pilot study, to measure burnout in pediatric residents before and after the implementation of a 3 month mindfulness-based meditation curriculum. Methods Used Comparison was made between a pilot study in mindfulness conducted in the department of pediatrics in 2019, and a Phase II in the departments of pediatrics and pastoral care in 2021. The outcome measures were: number of participants attending the sessions and the percentage compliance in filling the initial survey, final survey and post-meditation short surveys. The changes implemented included interdepartmental participation, increase in the number of 'mindfulness ambassadors', making attendance possible virtually (online) as well as physical presence, and making the surveys accessible online instead of paper-only (see table 2). Summary of Results There was a 20% increase in compliance filling the initial and final surveys between the pilot study and phase II (see figure 1). There was also a 30% increase in compliance with post-meditation surveys in 2021 as compared to the pilot study in 2019. It's noteworthy that phase II occurred during the first peak of the COVID pandemic, when residents were stretched thin. It was difficult ensuring consistent participation secondary to this, but phase II showed increased compliance in spite of these challenges. Conclusions Survey participation with consequent increase in the power of the study is critical in making survey-based research studies relevant. The integrity of such studies is often compromised by attenuation in the numbers of participants, as well as incomplete survey filling as a result of 'survey fatigue'. Valuable lessons were learned during the pilot study and when changes were implemented in the subsequent study, statistical power increased, proving higher relevance and effectiveness. (Table Presented).

Diurnal Variability of SARS-CoV-2 RNA Concentrations in Hourly Grab Samples of Wastewater Influent during Low COVID-19 Incidence

Wastewater-based epidemiology (WBE) has been widely deployed during the COVID-19 pandemic, but with limited evaluation of the utility of discrete sampling for large sewersheds and low COVID-19 incidence. In this study, SARS-CoV-2 RNA was measured in 72 consecutive hourly influent grab samples collected at a wastewater treatment plant serving nearly 500000 residents when incidence was low (approximately 20 cases per 100000). We characterized diurnal variability and relationships between SARS-CoV-2 RNA detection and physicochemical covariates [flow rate, total ammonia nitrogen (TAN), and total solids (TS)]. The highest detection rate observed was 82% during the first peak flow, which occurred in the early afternoon (14:00). Higher detection rates were also observed when sampling above median TAN concentrations (71%;p < 0.01;median = 40.26 mg of NH4/L). SARS-CoV-2 RNA concentrations were weakly correlated with flow rate (Kendall's τ = 0.16;p < 0.01), TAN (τ = 0.19;p < 0.05), and TS (τ = 0.18;p < 0.01), suggesting generally low RNA sewer discharges as expected at low incidence. Our results elucidated sensible adjustments to maximize detection rates, including using multiple gene targets, collecting duplicate samples, and sampling during higher flow and TAN discharges. Optimizing the lower-incidence bounds of WBE can help assess its suitability for verifying COVID-19 reemergence or eradication. ©

Alternative Workflow for SARS-CoV-2 Testing Using a Heat Lysis Protocol for Respiratory Specimens

Background. The SARS-CoV-2 pandemic has demonstrated the need for streamlined workflows in high-throughput testing. In extraction-based testing, limited extraction reagents and required proprietary instrumentation may pose a bottleneck for labs. As a solution, ChromaCode developed a Direct Extraction protocol for the HDPCR™ SARS-CoV-2 Assay, distributed in accordance with the guidance on Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency, Section IV.C., which allows for the processing of specimens without an extraction system. In lieu of an extraction system, the Direct Extraction protocol uses a thermal cycler to lyse and inactivate specimens which are directly added to the Polymerase Chain Reaction (PCR). Methods. The Limit of Detection (LoD), Clinical Performance, and effect of Interfering Substances was determined for the Direct Extraction protocol. The LoD was established on 6 PCR platforms with dilutions of inactivated SARS-CoV-2 virus spiked into residual, negative nasopharyngeal swab (NPS) matrix. Clinical performance was assessed with 48 positive and 50 negative frozen retrospective samples using the Direct Extraction protocol compared to an external Emergency Use Authorized (EUA) comparator assays (cobas® Liat® SARS-CoV-2 & Influenza A/B assay and the Hologic Panther Fusion® SARS-CoV-2 Assay respectively) on three PCR platforms. The Direct Extraction protocol was evaluated for performance in the presence of 13 potentially interfering substances that can be present in a respiratory specimen. Results. The LoD of the Direct Extraction protocol ranges from 1000 - 3000 genomic equivalents (GE)/mL. The clinical performance of the assay was 95.8% positive agreement (95% CI of 84.6% - 99.3%) and 100% negative agreement (95% CI of 90.9% - 100% or 91.1% - 100%) across all three PCR platforms tested. The viral target was detected at 3X LoD for all interferents tested. Conclusion. The Direct Extraction protocol of ChromaCode's SARS-CoV-2 Assay is a sensitive test that eliminates the need for sample extraction and performs very well against traditional extraction-based workflows. The inclusion of this protocol can reduce costs, reliance on extraction systems, and time associated with extraction-based protocols.

Plasma Discharge Ionization Emission Spectra of Analytes and SARS-CoV-2 for Label-Free Sensing Applications

Ionization spectra of substances are extensively used in their label free detection. Here we demonstrate the possibility of using plasma ionization to detect airborne and saliva SARS-COV-2 viruses through their emission spectra. It consists of an ionization chamber monitored by a fiber-optic UV-VIS spectrometer. The technique is completely label-free and can be programmed in real-time to detect different viral particles through their ionization emission spectra. Its average sensitivity for detecting deoxyribonucleic acid (DNA) bases in water is 20%/g in 1 mL of water. Its selectivity for DNA bases is through their relative emission peaks for adenine at 439.5 nm, cytosine at 440, thymine at 440.5, and guanine at 421.5 nm. The emission spectra of different electrode materials were also obtained to account for their contributions to the emission spectra of analytes. Gold electrodes were used owing to their resistance to corrosion and very low reaction with ionized species. The technique has the potential to be used in the point-of-care diagnostic and testing applications. IEEE

Suboptimal Humoral and Cellular Immune Response to SARS-CoV-2 RNA Vaccination in Myeloma Patients Is Associated with Anti-CD38 and BCMA-Targeted Treatment

Background: Multiple myeloma (MM) patients are immunocompromised due to defects in humoral/cellular immunity and immunosuppressive therapy. Reports indicate that the antibody (Ab) response in MM after 1 dose of SARS-CoV-2 RNA vaccine is attenuated. The impact of treatment on cellular immunity after vaccination remains unknown. Methods: We analyzed SARS-CoV-2 spike-binding (anti-S) IgG level in 320 MM patients receiving SARS-CoV-2 RNA vaccination. Blood and saliva were taken at multiple time points and compared with serology data of 69 age-matched vaccinated healthcare workers. We profiled SARS-CoV-2-specific T cell responses in a subset of 45 MM patients and 12 age-matched healthy controls by flow cytometry and ELIspot. All subjects were enrolled in studies approved by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai. Results: The 320 patients (median age 68 year) received two-dose RNA vaccines (69.1% BNT162b2, 27.2% mRNA-1273). Median time to diagnosis was 60 months with a median of 2 prior treatment lines (range 0-16). We included 23 patients with smoldering MM. Patients received various treatments at vaccination with 148 (43.8%) on anti-CD38-containing treatment, 36 (11.3%) on BCMA-targeted therapy and 59 (18.4%) not on active treatment (incl. SMM patients). At the last available evaluation prior to vaccination, 131 (40.9%) exhibited a complete response. At data cutoff, a total of 260 patients (81.3%) had anti-S IgG measured >10 days after the second vaccine (median 51 days). Of these, 84.2% mounted measurable anti-S IgG levels (median 149 AU/mL). In the control group, Ab levels were significantly higher (median 300 AU/mL). Ab levels in the vaccinated MM patients with prior COVID-19 were 10-fold higher than those of patients without prior COVID-19 (p<0.001). Repeat Ab measurements up to 60 days after second vaccination confirm delayed and suboptimal IgG kinetics, particularly in patients receiving anti-MM treatment compared to controls (Figure 1). MM patients on active treatment had lower anti-S IgG levels (p=0.004) compared to patients not on therapy (median 70 vs 183 AU/mL). Notably, 41 patients (15.8%) failed to develop detectable anti-S IgG: 24/41 (58.5%) were on anti-CD38, 13/41 (31.7%) on anti-BCMA bispecific Ab therapy and 4/41 (9.8%) >3 months after CAR T. Univariate analysis showed an association of disease-related factors with absence of anti-S IgG: more previous lines of treatment (>3 lines, p=0.035;>5 lines, p=0.009), receiving active MM treatment (p=0.005), grade 3 lymphopenia (p=0.018), receiving anti-CD38 therapy (p=0.042) and receiving BCMA-targeted therapy (p<0.001). Multivariate analysis (corrected for age, vaccine type, lines of treatment, time since diagnosis, response status and lymphopenia) confirmed that anti-CD38 (p=0.005) and BCMA-targeted treatment (p<0.001) are associated with not developing detectable anti-S IgG. Clinical relevance is emphasized by 10 cases of COVID-19 after 1 (n=7) or 2 vaccine doses (n=3, all without anti-S IgG) with 1 patient passing due to respiratory failure. We studied SARS-CoV-2-specific T cell responses >2 weeks after the second vaccine in 18 MM patients with undetectable anti-S IgG (seronegative), 27 with detectable anti-S IgG (seropositive) and 12 healthy seropositive controls. We found that seropositive MM patients had CD4+CD154+ T cells producing IFNg, TNFa and IL-2 at similar levels as controls, whereas in the seronegative MM cohort CD4 T cell responses were significantly reduced (p<0.005). SARS-CoV-2-specific CD8 T cell responses were overall weaker and not different across cohorts. This data suggests that absence of detectable IgG is associated with suboptimal response of humoral and cellular immunity. Conclusion: MM patients mount a suboptimal IgG response after SARS-CoV-2 vaccination, with 15.8% of patients without detectable anti-S IgG. Ongoing analyses will highlight durability of serological protection against COVID-19. Additional data on T cell responses and immunophenotyping in the context of vaccination will be upda ed at the meeting. Implications are continuation of non-pharmacological interventions, e.g. masking/social distancing, for vulnerable patients. The findings underscore a need for serological monitoring of MM patients after vaccination and for trials assessing use of prophylactic strategies or studies exploring additional immunization strategies. [Formula presented] Disclosures: Wang: Sanofi Genzyme: Consultancy. Chari: Karyopharm: Consultancy, Membership on an entity's Board of Directors or advisory committees;Seattle Genetics: Membership on an entity's Board of Directors or advisory committees, Research Funding;Millenium/Takeda: Consultancy, Research Funding;Sanofi Genzyme: Consultancy, Membership on an entity's Board of Directors or advisory committees;Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees;Pharmacyclics: Research Funding;GlaxoSmithKline: Consultancy, Membership on an entity's Board of Directors or advisory committees;Secura Bio: Consultancy, Membership on an entity's Board of Directors or advisory committees;Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Antengene: Consultancy, Membership on an entity's Board of Directors or advisory committees;Oncopeptides: Consultancy, Membership on an entity's Board of Directors or advisory committees;Novartis: Consultancy, Research Funding;Janssen Oncology: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Shattuck Labs: Consultancy, Membership on an entity's Board of Directors or advisory committees;BMS/Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Takeda: Consultancy, Research Funding;AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees. Cordon-Cardo: Kantaro: Patents & Royalties. Krammer: Kantaro: Patents & Royalties;Merck: Consultancy;Pfizer: Consultancy;Avimex: Consultancy;Seqirus: Consultancy. Jagannath: Legend Biotech: Consultancy;Karyopharm Therapeutics: Consultancy;Janssen Pharmaceuticals: Consultancy;Bristol Myers Squibb: Consultancy;Sanofi: Consultancy;Takeda: Consultancy. Simon: Kantaro: Patents & Royalties. Parekh: Foundation Medicine Inc: Consultancy;Amgen: Research Funding;PFIZER: Research Funding;CELGENE: Research Funding;Karyopharm Inv: Research Funding.

A Study of Social Network Messages During the COVID-19 Infodemic: Salient Features and the Propagation of Information Types

Amid a world of the COVID-19 pandemic, people often have turned to social media as a means of communicating and receiving information. Within existing social networks one can discover a wide range of messages that vary in sentiment, measure of helpfulness, and/or intended harm. In this paper, we measure the utility of Tweets based on their ability to propagate throughout the Twittersphere as well as the salient features that contribute to their successful propagation. In this work, we consider five types of Tweets that can be classified as: (1) Caution & Advice, (2) Doubt & Criticism, (3) Rumor & Counter-Rumors, (4) Generic Harm, and (5) Non-Situational Information. Our results suggest that, on average, Caution & Advice messages propagate fastest while messages classified as Generic Harm have the slowest propagation.

A study of social network messages during the COVID-19 infodemic: Salient features and the propagation of information types

Amid a world of the COVID-19 pandemic, people often have turned to social media as a means of communicating and receiving information. Within existing social networks one can discover a wide range of messages that vary in sentiment, measure of helpfulness, and/or intended harm. In this paper, we measure the utility of Tweets based on their ability to propagate throughout the Twittersphere as well as the salient features that contribute to their successful propagation. In this work, we consider five types of Tweets that can be classified as: (1) Caution Advice, (2) Doubt Criticism, (3) Rumor Counter-Rumors, (4) Generic Harm, and (5) Non-Situational Information. Our results suggest that, on average, Caution Advice messages propagate fastest while messages classified as Generic Harm have the slowest propagation. © 2021 IEEE.

Identifying barriers to caring for older adults during the coronavirus pandemic: A local needs assessment

Introduction: The COVID-19 pandemic has disproportionately affected older adults. Older adults not only have worse coronavirus outcomes but also face significant disruptions in their medical and home care, and social support networks. The pandemic highlights the importance of geriatric and dementia services and the ongoing shortage of health professionals within these fields. We collaborated with Alzheimer's Association Connecticut to develop an e-curriculum to educate caregivers on how best to care for affected seniors during this public health crisis. Methods: We set out to design a novel, blended-learning intervention to improve COVID-19-related geriatric and dementia education. Stakeholder discussions and semi-structured interviews with caregiver support staff and educators were carried out as part of a local needs assessment. Four central themes were identified during these interviews and are now being used to develop an interactive animation-based curriculum on the challenges of administering care for older adults during the pandemic. Results: Our initial focus group with caregiver support staff and educators identified the following key challenges: 1) social isolation, 2) caregiver fatigue, 3) safety issues, and 4) difficulty navigating the healthcare system with COVID-19. We are developing 10 minute educational videos that focus on each of these four themes and incorporate 2-D vector animation and whiteboard style teaching. An additional video will discuss the biology of COVID and why elderly/cognitively impaired adults are at increased risk. Conclusion: Through a local needs assessment, we identified four themes as barriers to providing care for older adults in the COVID-19 era. This information will be used to create an e-curriculum to increase caregivers' confidence and comfort with supporting older adults during the current health crisis. This content may also facilitate important discussions beyond COVID-19 as challenges like caregiver burden and social isolation are not unique to the pandemic.