A qualitative analysis of the impact of COVID-19 restrictions on gender biases in an Irish University.

This paper explores the impact of COVID-19 restrictions on gender biases in a STEM Faculty in an Irish University. For the purposes of this research, gender bias was understood as gender-based inclinations or prejudices which affect researchers' personal and professional opportunities as described by fifteen interviewees (nine women, six men). We used thematic interviews to explore participants' perspectives. Analyzing interviews with an inductive approach showed that gender biases experienced before COVID-19 restrictions were different from biases during restrictions. In discussing gender biases prior to the pandemic, interviewees mentioned institutional disparities, discrimination, implicit biases, stereotypes and gender roles. When discussing gender issues during COVID restrictions, interviewees mentioned disparities at home, challenges involved in parenting, support from colleagues and the University, as well as negative and positive impacts of restrictions on existing gender issues. Our results show that while COVID-19 restrictions and the associated consequences constrained all gender groups, they most negatively affected women researchers with caring responsibilities. Moving forward, reducing gender disparities requires promoting a horizontal organizational structure, and adjusting policies and work arrangements to cater for vulnerable cohorts such as parents, and international and early-career researchers. Offering a hybrid working model that grants more flexibility to those with caring responsibilities and which accommodates personal circumstances would help improve the working conditions for all researchers and nurture an organizational culture of care for the employees; thereby also fostering gender equity and tolerance.

Utility of the NECPAL CCOMS-ICO© tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study.

BACKGROUND: The Surprise Question (SQ) identifies patients with palliative care needs. The NECPAL CCOMS-ICO© (NECPAL) tool combines the Surprise Question with additional clinical parameters for a more comprehensive assessment. The capacity of these screening tools to predict mortality is still unknown. AIM: To explore the predictive validity of the NECPAL and SQ to determine 12- to 24-month mortality. DESIGN: Longitudinal, prospective and observational cohort study. SETTING/PARTICIPANTS: Three primary care centres, one general hospital, one intermediate care centre, and four nursing homes. Population cohort with advanced chronic conditions and limited life prognosis. Patients were classified according to SQ and NECPAL criteria and followed for 24 months. RESULTS: Data available to assess 1059 of 1064 recruited patients (99.6%) at 12 and 24 months: 837 patients were SQ+ and 780 were NECPAL+. Mortality rates at 24 months were as follows: 44.6% (SQ+) versus 15.8% (SQ-) and 45.8% (NECPAL+) versus 18.3% (NECPAL-) ( p = 0.000). SQ+ and NECPAL+ identification was significantly correlated with 24-month mortality risk (hazard ratios: 2.719 and 2.398, respectively). Both tools were highly sensitive (91.4, CI: 88.7-94.1 and 87.5, CI: 84.3-90.7) with high negative predictive values (84.2, CI: 79.4-89.0 and 81.7, CI: 77.2-86.2), with low specificity and positive predictive value. The prognostic accuracy of SQ and NECPAL was 52.9% and 55.2%, respectively. The predictive validity was slightly better for NECPAL. CONCLUSION: SQ and NECPAL are valuable screening instruments to identify patients with limited life prognosis who may require palliative care. More research is needed to increase its prognostic utility in combination with other parameters.

Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia.

Palliative care (PC) has focused on patients with cancer within specialist services. However, around 75% of the population in middle-income and high-income countries die of one or more chronic advanced diseases. Early identification of such patients in need of PC becomes crucial. In this feature article we describe the initial steps of the NECPAL (Necesidades Paliativas [Palliative Needs]) Programme. The focus is on development of the NECPAL tool to identify patients in need of PC; preliminary results of the NECPAL prevalence study, which assessed prevalence of advanced chronically ill patients within the population and all socio-health settings of Osona; and initial implementation of the NECPAL Programme in the region. As first measures of the Programme, we present the NECPAL tool. The main differences from the British reference tools on which NECPAL is based are highlighted. The preliminary results of the prevalence study show that 1.45% of the total population and 7.71% of the population aged over 65 are 'surprise question' positive, while 1.33% and 7.00%, respectively, are NECPAL positive, and surprise question positive with at least one additional positive parameter. More than 50% suffer from geriatric pluri-pathology conditions or dementia. The pilot phase of the Programme consists of developing sectorised policies to improve PC in three districts of Catalonia. The first steps to design and implement a Programme to improve PC for patients with chronic conditions with a public health and population-based approach are to identify these patients and to assess their prevalence in the healthcare system.

Identification of the sensorimotor cortex with functional MRI: frequency and actual contribution in a neurosurgical context.

BACKGROUND AND PURPOSE: We assessed the actual frequency of motor functional MRI (fMRI) in a neurosurgical environment and estimated the extent to which it aided surgeons' identifications of the sensorimotor cortex. METHODS: During five consecutive years, an fMRI protocol aimed at generating a selective activation of the hand cortical area was prescribed to 147 patients showing a centrally located space-occupying lesion, which represents 6.7% of all assisted surgical candidates showing an intracranial mass. Three senior neurosurgeons indicated the position of the sensorimotor cortex on two different anatomical displays, reporting confidence ratings for each decision. RESULTS: The sensorimotor cortex could not be identified in 16.5% of cases using conventional anatomical MRI, and in 15% of cases using 3-dimensional reconstructions. In an additional 12.5% of cases, the neurosurgeons were not confident when they correctly identified the sensorimotor cortex. The tumor distorting effect on central region anatomy significantly contributed to sensorimotor cortex misidentification. fMRI, by contrast, showed a selective activation indicating the position of the sensorimotor cortex in all but 4% of cases. CONCLUSIONS: In our neurosurgical environment, fMRI was prescribed to a selected group of surgical candidates showing a centrally located brain lesion. Compared to conventional anatomical imaging, fMRI does appear to improve the identification of sensorimotor cortex.

Resonancia magnética funcional de la respuesta cerebral al dolor en pacientes con diagnóstico de fibromialgia / Functional magnetic resonance imaging of the brain's response to pain in patients with a diagnosis of fibromyalgia

Introducción: El dolor es una experiencia subjetiva difícilmente evaluable por su variada expresión. Actualmente, la resonancia magnética funcional (RMf) permite objetivar la respuesta cerebral al estímulo doloroso. Objetivo: Evaluar la respuesta cerebral al dolor en pacientes con dolor crónico esencial generalizado diagnosticados de fibromialgia (FM). Sujetos y métodos: Se administró un estímulo doloroso por presión mecánica a 15 pacientes con FM y 11 controles durante la adquisición de RMf. Se realizaron diversos ensayos de activación variando la presión ejercida sobre una superficie de 1 cm2 del dedo pulgar. Resultados: Durante la adquisición de RMf, la aplicación de una presión mecánica de 4 kg no ocasionó molestias relevantes en ningún sujeto control. Contrariamente, todos los pacientes, excepto uno, refirieron dolor moderado-grave con este estímulo. La RMf puso de manifiesto que, con poca presión (4 y 5 kg), es excepcional la activación de regiones distintas al área sensitivomotora primaria contralateral al dedo estimulado en los sujetos control. Sin embargo, 5 pacientes (p = 0,027), a 4 kg de presión, y 7 (p = 0,030), a 5 kg, activaron las regiones cerebrales conocidas como mediadoras de la respuesta al dolor (área sensitivomotora primaria, corteza parietal, ínsula y región del cíngulo anterior). Conclusiones: Los resultados sugieren que una proporción significativa de pacientes diagnosticados de FM y con bajo umbral doloroso presentan una consistente respuesta cerebral al dolor con estímulos mecánicos de baja intensidad, mientras que en otra parte de los casos el cerebro responde de forma similar a los sujetos control

Introduction: Pain is a subjective experience that is difficult to evaluate due to its varied expression. Currently, functional magnetic resonance imaging (fMRI) can reveal the brain's response to painful stimuli. Objective: To evaluate the brain's response to pain in patients with chronic generalized essential pain diagnosed with fibromyalgia (FM). Subjects and Methods: Pain stimulus through mechanical pressure was administered to 15 patients with FM and to 22 control subjects while fMRI was carried out. Several attempts at activation were performed, varying the pressure exerted on a 2 cm2 surface of the thumb. Results: During acquisition of fRMI, none of the control subjects experienced significant discomfort when mechanical pressure of 4 kg was applied. However, all patients except one reported moderate-severe pain with the same stimulus. fMRI revealed that with slight pressure (4 and 5 kg), activation of areas other than the primary sensory-motor area contralateral to the stimulated thumb was exceptional in controls. However, 5 patients (p = 0.027) at 4 kg of pressure and seven (p = 0.030) at 5 kg of pressure showed activation of brain regions known to be mediators of pain response (primary sensory-motor area, parietal cortex, insula, and anterior cingulum). Conclusions: The results of this study suggest that in a significant proportion of patients diagnosed with FM and with a low pain threshold, there is a consistent brain response to low-intensity mechanical stimuli while in another proportion of patients, the response of the brain to painful stimuli is similar to that of control subjects