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Bioethics education in residency helps trainees achieve many of the Accreditation Council for Graduate Medical Education milestones and gives them resources to respond to bioethical dilemmas. For this purpose, The Providence Center for Health Care Ethics has offered a robust clinical ethics rotation since 2000. The importance of bioethics for residents was highlighted as the COVID-19 pandemic raised significant bioethical concerns and moral distress for residents. This, combined with significant COVID-19-related practical stressors on residents led us to develop a virtual ethics rotation. A virtual rotation allowed residents flexibility as they were called to help respond to the unprecedented demands of a pandemic without compromising high quality education. This virtual rotation prioritized flexibility to support resident wellbeing and ethical analysis of resident experiences. This article describes how this rotation was able to serve residents without overstraining limited bandwidth, and address the loci of resident pandemic distress. As pandemic pressures lessened, The Providence Center for Health Care Ethics transitioned to a hybrid rotation which continues to prioritize resident wellbeing and analysis of ongoing stressors while incorporating in-person elements where they can improve learning. This article provides a description of the rotation in its final form and resident feedback on its effectiveness.
Firms are calling their employees back to the office because of concerns about employee productivity, collaboration, and trust. Thus, knowledge about the psychosocial aspects of virtual work environments is now more essential than ever. This study compared the relationships between mutual cognitive trust and employee performance in virtual and face-to-face leader–member dyads. Numerous studies have adopted a unidirectional approach to leader–member trust, exhibiting difficulties related to common method bias. The validity of previous research results comparing trust in face-to-face and virtual leader–member dyads can also be questioned because of other methodological drawbacks. We examined mutual trust and employee performance using different raters. We utilised the multigroup exploratory approach to simultaneously analyse face-to-face and virtual dyads formed by 180 leaders and 561 employees working at a multilatina company. Our results reveal the existence of differences between virtual and face-to-face leader–member dyads vis-à-vis mutual cognitive trust and employee performance relationship.
While caring for seriously ill children is a rewarding experience, pediatric healthcare providers may experience sadness and emotional distress when their patient dies. These feelings, particularly when not addressed, can lead to negative health and occupational outcomes. Remembrance practices can provide a safe space for staff to process their grief. This study explored pediatric healthcare providers’ perceptions of an annual Pediatric Remembrance Ceremony (PRC) and a quarterly program, Good Grief and Chocolate at Noon (GGCN), to learn what components of the programs were considered meaningful and the personal impact on those who attended. The programs pivoted to a virtual platform during the COVID-19 pandemic, and the study also assessed providers’ perspectives of attending the programs virtually.
Methods
A 19 multiple choice survey instrument was designed, reviewed, piloted, revised, and re-piloted by an interdisciplinary bereavement committee prior to administration. The survey included 2 open-ended questions, inviting additional insights into personal impact and future directions for remembrance programs. The survey was administered on an encrypted online platform.
Results
Components of the PRC respondents most valued included the opportunity for staff to choose a name of a patient they cared for and to light a candle for that patient as their name is read. Those who participated in GGCN found story sharing helpful, along with having a speaker address a topic around loss and grief during the second half of the session. Both programs provided reflection, solidarity, and memorialization. Most respondents prefer having both in-person and virtual options.
Significance of results
Healthcare providers are affected by the death of the children they care for and value opportunities provided to join colleagues in remembering their patients. The findings underscore the value of remembrance programs in supporting bereaved staff.
Edited by
Andrea Fiorillo, University of Campania “L. Vanvitelli”, Naples,Peter Falkai, Ludwig-Maximilians-Universität München,Philip Gorwood, Sainte-Anne Hospital, Paris
Advances in technology have virtually transformed communication and interaction modalities. Telemental health provides the advantages to reach those patients who may otherwise have limited mental health care delivery due to the lack of specialty professionals, limited financial resources to face costs and lost wages for travel to distant clinics, or go without services altogether. Remote technologies, including telemental health and telepsychiatry, broadly became a cost-effective and complementary tool to overcome restricted clinical practices, safely engage, and manage patients suffering with mental disorders who need care, support, and treatment. Although most research to date has demonstrated adequate comparability to traditional in-person modalities to deliver mental health care, there remain some concerns among professionals regarding the implementation of telemental health and telepsychiatry in routine clinical practice, as there may be a set of technological and logistic barriers as well as safety, privacy, and confidentiality issues to be addressed.
New technologies hold great promises of making crisis response better. These technologies may improve information positions and enable faster communication as well as produce more rapid and targeted responses in crises. As such, technological progress boosts effectiveness and efficiency, while reducing risks to frontline responders. Still, the reality does not always match these great expectations due to technical failures and implementation difficulties as well as persistent social problems that cannot be resolved by new tools or systems. There are often even undesirable side effects. The dilemma for frontline responders revolves around finding the right attitude toward new technologies. Technological progress is a historical inevitability, but new innovations should only be adopted if these match a recognized problem in the response and not just for their own sake. There are guiding principles, based on earlier experiences, that offer useful insights in how to best incorporate modern tools and systems. This requires a prudent approach that considers new technology with a mix of hesitation and curiosity.
The unprecedented COVID-19 pandemic has caused restrictive measures to be established in many sectors including the legal and judicial sector; an example is the use of electronic litigation systems and video-conferencing facilities for trials. With the implementation of changes in the legal and judicial sector to adapt to restrictions arising from the pandemic, there is the question of whether the current rules governing civil-court proceedings are designed to accommodate these changes. This article seeks to explore the measures taken by courts in response to the pandemic with a focus on Asia, notably Singapore. The article will outline the legal basis for the use of live video links for the purpose of witness evidence-taking under Singapore law and the possible implications will be reviewed taking Singapore’s civil proceedings as an example in comparison with other jurisdictions.
Dance for older adults is increasingly being used to support health and well-being. While dance may be enjoyable for many, understanding its benefits for those with limited physical and cognitive abilities may provide further support for how dance may be used in these contexts. This was a study of Sharing Dance Older Adults, a dance program with remotely streamed sessions. Data were collected from 48 older adults who took part in the On Your Feet version of the program, and from 38 who took part in the In Your Seat version. Measures included interviews, physical fitness tests and surveys on mood, quality of life, and program satisfaction. Physical fitness significantly improved for both groups, unlike for mood, social well-being, or quality of life. This contrasts with qualitative findings, with participants reporting how the program enhanced their mood, social interactions, and quality of life.
Online delivery is new to the field of music therapy (MT). This research investigated older adults’ perceived quality of MT online by certified music therapists. In this feasibility study, applying both process and outcome assessments, nine older adults volunteered to participate. Zoom was used, and a virtual music therapy (VMT) kit was developed as a resource. Surveys and observed technical difficulties revealed that perceived quality varied slightly by level of technical difficulty experienced; however, overall mean perceived quality was 7.2 out of 9. Post-study interviews revealed three main themes: (a) individual experiences with VMT, (b) individuals’ suggestions for further development of VMT sessions, and (c) individuals’ personal outcomes from VMT sessions. Participants reported overall positive experiences with VMT. Despite a slight decline in perceived quality when more technical difficulties were present, each participant reported a desire for more sessions, and they would recommend it to others.
Effective doctor–patient communication is a core competency for healthcare professionals. With the pivot to online clinical education and assessment due to the COVID-19 pandemic, there was a need to explore the views of psychiatric trainees and examiners on assessment of communication skills during online high stakes postgraduate examinations.
Methods:
The study was designed as descriptive qualitative research. All candidates and examiners of the September and November 2020 sitting of online Basic Specialist Training exam (a clinical Objective Structured Clinical Examination exam completed in the first 4 years of psychiatry training) were invited to participate. The respondents were interviewed by Zoom which was transcribed verbatim. Data were analyzed by NVivo20 pro and various themes and subthemes were drawn using Braun and Clarke thematic analysis.
Results:
A total of seven candidates and seven examiners were interviewed with an average duration of 30 minutes and 25 minutes, respectively. Four main themes emerged: Communication, Screen optimization, Continuation postpandemic and Overall experience. All candidates preferred to continue an online format post pandemic for practical reasons e.g., avoiding travel and overnight stay, while all examiners preferred to go back to in-person Objective Structured Clinical Examination. However, continuation of online Clinical Formulation and Management Examination was agreed by both groups.
Conclusion:
The participants were largely satisfied with the online examination but did not consider it equal to face-to-face for picking up nonverbal cues. Overall minimal technical issues were reported. These findings may be helpful to modify current psychiatry membership examinations or similar assessments in other countries and specialties.
This chapter describes and expands upon virtue ethical and virtue theoretical approaches to moral education in and for virtual spaces. Building on existing claims that virtual spaces call for new kinds of virtues, we argue that structural constraints make risks and vices especially hard to overcome in these contexts. We organize these constraints around a threefold approach to integrity, according to how they hinder knowledge, self-efficacy, and self-unity. We then turn to positive recommendations for removing these barriers. We outline implications for end users by exploring the need for the development of the “burdened virtues”, applying ideas from Lisa Tessman. We also consider what it would look like for this kind of moral development to be supported by educators, policy-makers, and other leaders within the tech ecosystem. We suggest that the way forward will be to educate for and build spaces in which the online and offline worlds are drawn into closer alignment, supporting integrity in all its forms.
Media and communication influence, shape, and change our societies. Therefore, this first chapter aims to explain the implications of digital communication for our societies and the relationship between media, technology, and society. The chapter introduces the concept of society from a sociological perspective and explains how societies change because of the effects technological developments have on them, and vice versa. It illustrates this interplay with the example of digital divides.
In order to explain the significance and changes of public communication in a digital society, the chapters zooms in on the media landscape and explicates the difference between new media and old (or traditional) media. It pays particular attention to the ideas of Marshall McLuhan, as his work remains a cornerstone when studying the relationship between media, technology, and society. The chapter then outlines the discipline of media linguistics and explains how media linguistics can help to make digital media and digital communication more tangible. It focuses on three key terms crucial for understanding public digital communication: multimodality, media convergence, and mediatization.
Undergraduate research in mathematics is growing and has become a standard practice in some countries. However, for a novice there is much to learn about mentoring students in mathematics research. In this chapter, we discuss the state of undergraduate research in mathematics and detail a set of best practices for successfully mentoring undergraduate students. Also, we explore some needs and future directions that would help improve undergraduate research in mathematics. Throughout the chapter, we include resources for more information on various topics.
Older adults experience symptoms of depression, leading to suffering and increased morbidity and mortality. Although we have effective depression therapies, physical distancing and other public health measures have severely limited access to in-person interventions.
Objective:
To describe the efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults.
Design:
Systematic review.
Setting:
We searched MEDLINE, EMBASE, Cochrane Libraries, PsycINFO, and gray literature from inception to July 5, 2021.
Participants and interventions:
We included randomized trials (RCTs) comparing the efficacy of virtual interventions to any other virtual intervention or usual care in community-dwelling adults ≥60 years old experiencing symptoms of depression or depression as an outcome.
Measurements:
The primary outcome was change in symptoms of depression measured by any depression scale.
Results:
We screened 12,290 abstracts and 830 full text papers. We included 15 RCTs (3100 participants). Five RCTs examined persons with depression symptoms at baseline and ten examined depression as an outcome only. Included studies demonstrated feasibility of interventions such as internet or telephone cognitive behavioral therapy with some papers showing statistically significant improvement in depressive symptoms.
Conclusions:
There is a paucity of studies examining virtual interventions in older adults with depression. Given difficulty in accessing in-person therapies in a pandemic and poor access for people living in rural and remote regions, there is an urgent need to explore efficacy, effectiveness, and implementation of virtual therapies.
Following the national lockdown in the UK in March 2020 in response to the COVID-19 pandemic, we instigated regular online tutorials for fourth year medical students undertaking their psychiatry placement.
Objectives
The aims of these tutorials were threefold: to ensure that students covered a range of key psychiatry topics, to enable them to have the opportunity for interactive tutorials with experienced psychiatrists and, not least, to create a sense of continuity and connection with their tutors and peers across the mental health block.
Methods
Each student was allocated to a tutorial group comprising 10 – 15 medical students and a psychiatrist facilitator. These groups met weekly for 7 consecutive weeks at an agreed time for 60 – 90 minutes via an online platform and all covered the same allocated topic each week. We evaluated these groups via an online survey sent to the students following the programme.
Results
The students rated the tutorials on average as 4.5/5 on whether they met the defined learning outcomes. On average the students did not consider that the virtual format made a significant difference to their learning, but this disguised a wide range of views that were expressed via a comment box.
Conclusions
The evaluation of this project supports the use of virtual tutorials as a valuable learning tool but educators need to be aware that student views’ on these can be varied and so, long-term, a blend of virtual and face to face learning is most likely to meet the needs of all students.
The Multi-Agency Autism Team (MAAT) diagnose Autism Spectrum Disorder (ASD) in children and young people using a multi-stage assessment process. In March 2020, the UK went into lockdown due to the COVID-19 pandemic, affecting the MAAT’s ability to continue their typical diagnostic pathway.
Objectives
This qualitative study aimed to assess the effectiveness and feasibility of a virtual ASD diagnostic pathway.
Methods
From March – September; one hundred detailed developmental history assessments were conducted over the telephone, fifteen socially-distanced BOSA (Brief Observation of Symptoms of Autism) assessments were piloted, twenty-five multi-disciplinary formulation meeting were held over a video platform, and sixty diagnosis feedback consultations were conducted via telephone or video call. Structured interviews were conducted with clinicians and service-users.
Results
revealed that telephone developmental history assessments were generally preferable over face-to-face appointments, and video-based formulation meetings were effective, productive and resulted in higher clinician attendance. The qualitative data on feedback appointments was mixed. Clinicians felt that telephone appointments were less personable and ethical; whereas, video-based feedback appointments allowed for more empathy. However, the majority of service-users opted for tele-calls over video-calls for these appointments. Socially-distanced BOSAs obtained positive clinician feedback in general. Service-user feedback was mixed; some found the experience uncomfortable and unfamiliar, whilst others enjoyed the experience. Overall, service-users were content with the knowledge that it may support a diagnostic outcome for their child.
Conclusions
We concluded that the overall experience of the virtual ASD diagnostic pathway was a positive and informative process, identifying opportunities for permanent change to the service.
The fourth chapter focuses on contemporary mobility paradigms and the ability of masjid space to travel and evolve in response to changing conditions of being. The case studies in this chapter push discussions of masjid space beyond considerations of three-dimensional form to accommodate the realities of individuals and groups on the move. The first case study focuses on the car rapides transport buses in the city of Dakar, which in many ways act as mobile masjids capable of transporting sanctification throughout the city. The second case study in this chapter follows the development of airport prayer spaces on the continent, whose spiritually ambiguous identities allow them to shift character in response to the bodies that inhabit them. The third case study in this chapter focuses on the emergence of virtual space, specifically the growing online terrain of the holy city of Touba (Senegal), which is increasingly operating beyond its geographic borders by expanding itself as a conceptual “territory” into a global digital environment. These case studies move masjid space beyond a tangibly rooted form toward privileging its reality as a flexible, mobile, and sometimes immaterial terrain that is able to realize itself beyond established hierarchies of physical presence.
Community engagement is important for advancing Clinical and Translational Science (CTS), but face-to-face engagement has limited reach and scale. We examined the feasibility of a novel virtual Facebook community platform for public engagement on health research statewide in Minnesota.
Methods:
The Facebook platform, MN Research Link, was evaluated from June 19, 2019 to June 30, 2020. Facebook advertisements and boosts were used to recruit followers. Content, based on prior formative work, included health research information and interactive postings (e.g., live interviews with researchers). Standard metrics obtained from Facebook analytics included participation (followers), content reach (views), and engagement (likes, shares, comments, clicks).
Results:
During the 12-month period, we acquired 1406 followers (31% rural residents), with a retention of followers of 99.7%. Mean number of views per month was 9379.83 (Mdn = 2791, range 724–41,510). Engagement metrics indicated a mean of 535.2 likes, shares, comments, and/or clicks per month (Mdn = 296.5, range 55–1535). The page continued to acquire new followers, but a slight decrease in engagement was observed in the final months after state COVID-19 mitigation strategies were implemented.
Conclusion:
As the complexity of CTS continues to grow, along with social distancing measures resulting from the COVID-19 pandemic, the availability of virtual digital platforms to reach and engage community stakeholders in conversations about health and research has increasing importance. Preliminary findings from this program evaluation indicate that a Facebook community platform is feasible to engage Minnesota residents in conversations around health and research topics. Future work will evaluate its potential for reach, scale, and sustainability.
This article examines the possible use of ‘virtual’ Eucharists in the Anglican Church of Australia in a time of a global pandemic such as exists in the world in 2020 with the spread of coronavirus or COVID-19. The changing nature of modern communication is considered in the context of the possibility of the use of a ‘virtual’ Eucharist, where a priest in one place with a set of bread and wine, consecrates the bread and wine, while at the same time a person in their own home consumes another set of bread and wine with the assumption that second set of bread and wine is also consecrated. Suggestions for and discussion of the use of a ‘virtual’ Eucharist in two dioceses of the Anglican Church of Australia are discussed with a consideration of published material by episcopal leaders. Biblical, theological and constitutional perspectives are then considered in relation to a ‘virtual’ Eucharist before the recommendation is made that ‘virtual’ Eucharists are not considered as appropriate at any time, including during a global COVID-19 pandemic, in the Anglican Church of Australia. Several alternatives to a ‘virtual’ Eucharist are considered which would allow people to obtain spiritual nourishment by other means.
Generalized continua represent a class of models whose potential applicability seems to have been underestimated. The mathematical structure of these models is discussed and the reasons why it has been underestimated are made clear. Their importance in the theory of metamaterials is highlighted and their potential impact on future technological applications is carefully argued. It is shown how the original ideas of Lagrange and Piola can be developed by using the modern tools of differential geometry, as formulated by Ricci and Levi-Civita. It has to be concluded that variational principles are the most powerful tool also in the mathematical modeling of metamaterials.
Whereas the rhetoric of new media at the turn of the millennium stressed the evolution from ‘seeing’ to ‘being’, artists who were most involved in the early stages of virtual reality have moved from the overoptimistic and perhaps almost hubristic notion of ‘being’ as an existential condition of virtual reality, to a far more realistic, humble and ecologically oriented notion of ‘being-in-common’. This contribution looks at two artists in particular – Char Davies and Gary Warner – and the focus of their current work.