Bedside rationing in cancer care: Patient advocate perspective

Rationing in healthcare remains very much a taboo topic. Before COVID-19, it rarely received public attention, even when it occurred in everyday practices, mainly in the form of implicit rationing, as it continues to do today. There are different definitions, types and levels of healthcare rationing, according to different perspectives. With the aim of contributing to a more coherent debate on such a highly emotional healthcare issue as rationing, here are provided a number of reflections from a patient advocate perspective which are specifically focused on bedside rationing, the most troublesome level, both for patients and clinicians, particularly in regard to cancer care. Oncology, with its numerous expensive therapies and increasing number of patients, is undeniably one of the main areas contributing to the increase in healthcare costs. However, the fixed budgets of today's publicly financed health systems cannot allow unlimited access to the potentially beneficial treatments to all patients. Bedside rationing constitutes the last phase of many decision-making processes occurring at different interrelated levels (macro-levels), both inside and outside healthcare systems, which implicitly and inevitably result in a bottleneck determined by the upstream decisions themselves. Shifting from implicit to explicit bedside rationing essentially means moving from a paternalistic to a citizen-before-patient approach; this implies, first of all, a cultural change. Practical bedside rationing is an ethically complex topic, but one that needs to be urgently addressed in a transparent and open debate. In this scenario, the oncological community – patients, patient advocates and clinicians – can and should play an important role.

De-territorialisations for pedagogical co-creation: Challenging traditionalistic pedagogies with students in higher education

The notion of pedagogy tends to be understood as the domain of teachers, this is a reductive way of thinking about pedagogy. Instead, in this paper I explore the heteroglossia of pedagogy through the Deleuzian-Guattarian notion of assemblage. Through this approach, pedagogy is an open debate which needs to involve students to co-create the learning environment in Higher Education (HE). Drawing on data collected with first year undergraduate students and through an action research methodological approach, I will argue that collaborative and progressive pedagogies in HE must go beyond the authority of the teacher and offer students in-class opportunities to negotiate the usual power relationships that characterise traditionalistic pedagogies. Whilst there is a stronger emphasis on engaging students differently in HE, it is important to also reflect on the dynamics that emerge from initiatives that seek to redress the pedagogical imbalances that the traditionalistic classroom perpetuates, such as enforcing a prescriptive curriculum where knowledge is transferable, inert and closely policed to satisfy performative regimes of assessment. I suggest that the notion of assemblages can help us understand the solidified and accepted classroom pedagogies as territories which are still normative in education, including HE, therefore, mapping out these territories open up possibilities for de-territorialisations.

A Newfound Empathy

The Boston Massacre occurred on March 5, 1770. Following the death of five Bostonians, both the American colonists and the royal officials in Boston took testimonies and sent them to London. Elected colonial agents issued motions to open debate on Parliament’s accountability in creating an imbalanced relationship between the military and civil authorities in the colonies. Unfortunately, the motions from these colonial agents were voted in the negative, leading to disappointment on both sides of the Atlantic. Two years prior, a similar tragedy happened in England: The Massacre of St. George’s Fields. Scottish soldiers accosted a British mob that had gathered to protest the arrest of MP John Wilkes. From 1768 to 1771, Parliament rejected motions that sought to reconcile the grievances that led to the Massacre of St. George’s Fields. After years of Parliament silencing colonial agents and liberal politicians, the British public began to express a stronger sense of understanding and empathy towards the American colonists, as evident by the outpouring of public support in the months following the Boston Massacre.

Antibody Persistence 6 Months Post-Vaccination with BNT162b2 among Health Care Workers

Background: We present immunogenicity data 6 months after the first dose of BNT162b2 in correlation with age, gender, BMI, comorbidities and previous SARS-CoV-2 infection. Methods: An immunogenicity evaluation was carried out among health care workers (HCW) vaccinated at the Istituti Fisioterapici Ospitalieri (IFO). All HCW were asked to be vaccine by the national vaccine campaign at the beginning of 2021. Serum samples were collected on day 1 just prior to the first dose of the vaccine and on day 21 just prior to the second vaccination dose. Thereafter sera samples were collected 28, 49, 84 and 168 days after the first dose of BNT162b2. Quantitative measurement of IgG antibodies against S1/S2 antigens of SARS-CoV-2 was performed with a commercial chemiluminescent immunoassay. Results: Two hundred seventy-four HWCs were analyzed, 175 women (63.9%) and 99 men (36.1%). The maximum antibody geometric mean concentration (AbGMC) was reached at T2 (299.89 AU/mL; 95% CI: 263.53–339.52) with a significant increase compared to baseline (p < 0.0001). Thereafter, a progressive decrease was observed. At T5, a median decrease of 59.6% in COVID-19 negative, and of 67.8% in COVID-19 positive individuals were identified with respect to the highest antibody response. At T1, age and previous COVID-19 were associated with differences in antibody response, while at T2 and T3 differences in immune response were associated with age, gender and previous COVID-19. At T4 and T5, only COVID-19 positive participants demonstrated a greater antibody response, whereas no other variables seemed to influence antibody levels. Conclusions: Overall our study clearly shows antibody persistence at 6 months, albeit with a certain decline. Thus, the use of this vaccine in addressing the COVID-19 pandemic is supported by our results that in turn open debate about the need for further boosts.

The Use of Distance Learning and E-learning in Students with Learning Disabilities: A Review on the Effects and some Hint of Analysis on the Use during COVID-19 Outbreak

Even if the use of distance learning and E-learning has a long tradition all over the world and both have been used to keep in contact with students and to provide lessons, support and learning materials, there is an open debate on the balance between advantages and disadvantages in the use of distance learning. This debate is even more central in their use to support students with Learning Disabilities (LDs), an overarching group of neurodevelopmental disorders that affect more than 5% of students. The current COVID-19 outbreak caused school closures and the massive use of E-learning all over the world and it put higher attention on the debate of the effects of E-learning. This paper aims to review papers that investigated the positive and negative effects of the use of Distance Learning and E-learning in students with LDs. We conducted a literature review on the relationship between Distance Learning, E-learning and Learning Disabilities, via Scopus, Eric and Google Scholar electronic database, according to Prisma Guidelines. The findings are summarized using a narrative, but systematic, approach. According to the data resulting from the papers, we also discuss issues to be analyzed in future research and in the use of E-learning during the current pandemic of COVID-19.

Data Co-Operatives through Data Sovereignty

Against the widespread assumption that data are the oil of the 21st century, this article offers an alternative conceptual framework, interpretation, and pathway around data and smart city nexus to subvert surveillance capitalism in light of emerging and further promising practical cases. This article illustrates an open debate in data governance and the data justice field related to current trends and challenges in smart cities, resulting in a new approach advocated for and recently coined by the UN-Habitat programme ‘People-Centred Smart Cities’. Particularly, this feature article sheds light on two intertwined notions that articulate the technopolitical dimension of the ‘People-Centred Smart Cities’ approach: data co-operatives and data sovereignty. Data co-operatives are emerging as a way to share and own data through peer-to-peer (p2p) repositories and data sovereignty is being claimed as a digital right for communities/citizens. Consequently, this feature article aims to open up new research avenues around ‘People-Centred Smart Cities’ approach: First, it elucidates how data co-operatives through data sovereignty could be articulated as long as co-developed with communities connected to the long history and analysis of the various forms of co-operatives (technopolitical dimension). Second, it prospectively anticipates the city–regional dimension encompassing data colonialism and data devolution.

When the Masks Come Off in Canada and Guatemala: Will the Realities of Racism and Marginalization of Midwives Finally Be Addressed?

This article addresses the effects of COVID-19 in Eastern and Northern Ontario, Canada, with a comparative glimpse at the small province of Totonicapán, Guatemala, with which Canadians have been involved in obstetric and midwifery care in particular over the last 5 years. With universal health care coverage since 1966 and well-integrated midwifery, Canada's system would be considered relatively well set up to deal with a disaster like COVID-19 compared to low resource countries like Guatemala or countries without universal health care insurance (like the USA). However, the epidemic has uncovered the fact that in Ontario, Indigenous, Black, and People of Color (IBPOC), as elsewhere, may have been hardest hit, often not by actually contracting COVID-19, but by suffering secondary consequences. While COVID-19 could be an issue through which health care professionals can come together, there are signs that the medical hierarchies in many hospitals in both Ontario and Totonicapán are taking advantage of COVID-19 to increase interventive measures in childbirth and reduce midwives' involvement in hospitals. Meanwhile, home births are on the rise in both jurisdictions. Stories from a Jamaican Muslim woman in Ottawa, an Indigenous midwifery practice in Northern Ontario, registered midwives in Eastern Ontario, and about the traditional midwives in Guatemala reveal similar as well as unique problems resulting from the lockdowns. While this article is not intended to constitute an exhaustive analysis of social justice and human rights issues in Canada and Guatemala, we do take this opportunity to demonstrate where COVID-19 has become a catalyst that challenges the standard narrative, exposing the old ruts and blind spots of inequality and discrimination that our hierarchies and inadequate data collection—until the epidemic—were managing to ignore. As health advocates, we see signs that this pandemic is resulting in more open debate, which we hope will last long after it is over in both our countries.

Pandemia y colapso capitalista

Este trabajo presenta algunos de los temas de un debate abierto sobre la naturaleza del tiempo presente, al que caracterizamos como colapso, para diferenciarlo de las crisis estructurales del sistema capitalista. Nos interesa resaltar que, en tiempos de la COVID-19, la catástrofe tiene largo rato expandiéndose en el mundo, por lo que es necesario hacer interpretaciones genealógicas que salgan de la trampa de lo novedoso. De manera específica, el texto resalta algunas de las trayectorias del colapso en América Latina. Derivamos así un análisis sobre las formas de gubernamentalidad en el contexto de colapso y las maneras en las que se actualiza durante la pandemia en América Latina. Pandemic and Capitalist Collapse. A View from Latin America Abstract: This work presents some of the topics of an open debate about the nature of the present time, which we characterize as collapse, to differentiate it from the structural crises of the capitalist system. We are interested in emphasizing that, in times of COVID-19, the catastrophe has been expanding in the world for a long time, so it is necessary genealogical interpretations that overcome the trap of the novelty. Specifically, the text distinguishes some of the trajectories of the collapse in Latin America. From these, we analyze the forms of governmentality in the context of collapse and the ways in which it is happening during the pandemic in Latin America. Keywords: collapse in Latin America, capitalism, pandemic, collapse governmentality.

La unión convivencial a la luz del derecho internacional privado argentino. / Some considerations about domestic partnerships in the ligth of argentine international private law

Con la sanción del Código Civil y Comercial de la Nación (CCCN) en 2015 se introdujo en el sistema legal argentino el instituto jurídico de la unión convivencial, siendo regulada en el mismo desde la doble concepción de derecho interno y de derecho internacionalprivado.El objetivo de este trabajo es hacer algunas consideraciones de dicho instituto desde la óptica del Derecho internacional privado y de los problemas que las normas que lo regulan sobre jurisdicción y derecho aplicable pueden acarrear en su interpretación y aplicación y proponer la discusión de una reforma de la norma reguladora del derecho aplicable acorde a las necesidades actuales del tráfico jurídico.ABSTRACT: With the enactment of the new Civil and Commercial Code of the Argentine Republic (CCC) in 2015, the legal concept known as domestic partnership was introduced into the Argentine legal system, and it was organized both from the perspective of domestic law and internationalprivate law. The goal of this paper is to provide various considerations as regards such legal concept in the light of both international private law and the problems that the norms regulating such concept may involve in terms of competence and applicable law, for interpretation and applicability purposes thereof. Besides, this work seeks to open debate for a reformulation of the norm regulating applicable law tailored to the current needs of legal workload.