Happy New Year from the Editor

Dear readers, advisors, authors, editors, and peer reviewers, As we welcome the new year, we look forward to the opportunity to publish new arguments and pose challenging questions about ethical dilemmas in the realm of medicine, science, and technology. Reflecting on the peer review process at this juncture seems especially important considering the bioethics climate and the challenges in doing justice to ethical dilemmas. Unlike scientific peer review, replicability, reliability, and evaluation of methods are largely irrelevant to much of the bioethics literature, except for empirical research. Much like papers published in law, the humanities, and social sciences, peer reviewing contextual arguments in bioethics requires us to evaluate argument validity and ensure that arguments are based on facts or appropriate hypotheticals. The risk that voices are quieted merely because the editorial staff or peer reviewers would choose the other side of an argument is high and requires mitigation steeped in serious processes built into the peer review system. It is especially important to hear diverse views that represent many points along a continuum during polarized times. The papers that offer conceptual arguments that we tend to publish at Voices in Bioethics call for an examination of logic and argument foremost, with a special emphasis on which conclusions are drawn from the premises supplied. At Voices in Bioethics, the peer review process aims to be inclusive, so we balance our instincts to criticize with our goal to accept as many papers that meet our guidelines as possible. We welcome new arguments, especially ones that highlight overlooked viewpoints, considerations, or stakeholders. We acknowledge how many great ideas result from people who speak English as a second or third language, or who do not use English at all. All of those affected by or who observe an ethical dilemma are welcome to submit their ethics arguments surrounding health care, technology, the environment, and the broader sciences. We are happy to read papers by those outside of bioethics and those with any level of education. We use the peer review questions about mechanics only to inform editors of what the process might entail. We do not accept or reject based on mechanics or style alone. The nature of many bioethics journals is to publish papers that may reflect the bioethics status quo or apply common bioethical frameworks to new problems. In addition to that, we try to showcase new ways of thinking and additional considerations. After all, publishing is not about publishing papers that mimic older well-cited articles or that apply only those frameworks learned in the classroom. It is about giving voice and contributing to an open access ecosystem where new and old ideas coexist, their worth measured not in hits or likes, but in their contribution to ethical analysis. Wishing a happy new year to our advisors, editors, peer reviewers, authors, and readers.

Taxonomic composition and condition of tree plantations of roadside strips in Kyiv

Aim. The analysis of the taxonomic composition and living condition of tree plantations of roadside strips in Kyiv. Methods. Determination of the species composition and viability of trees and shrubs was carried out by route survey on test areas along the routes with different traffic intensity. The plants living condition was established according to the methodology developed by us, which provides an integrated vitality assessment based on a set of morphometric, reproductive and phenological features. Results. It is established that in the conditions of traffic flow of high intensity 23, of moderate 27 and of low 29 species of trees and bushes were found on the test areas. The tree plants of most common genera and species of roadside plantations are identified. The plants living condition analysis showed, that in the conditions of traffic flow of high intensity, plants of moderate and low vitality predominate; while in the conditions of moderate and low traffic intensity, the predominant numbers of plants have high vitality. Conclusions. Analysis of the range of roadside plantations indicates its limited and almost complete absence of conifers. The species composition is not optimal and is not always determined by the degree of resistance to transport pollution specific conditions. The woody plants vitality is largely determined by the traffic intensity and compliance with care technology.

A Study of Cloud-Based Remote Clinical Care Technology

This paper uses cloud computing to build and design remote clinical care technology, and the study refines the evaluation approach for the elements and builds an evaluation prototype for the strategy, uses service design theory to improve the design of the service part of the assistive system, summarizes the list of requirements based on system design and service design, and designs a service design prototype. Through design practice, the detailed design of the software interaction interface and the auxiliary product of the care assistance system based on the prototype are investigated. Based on the user perspective, the strategy of meeting user expectations and improving user information literacy is proposed; based on the social network perspective, the strategy of establishing a long-term mechanism for smart medical operation and improving the information interaction network environment is proposed; and based on the system service perspective, the strategy of optimizing the system function design and innovating the service model is proposed. Compared with the traditional written patient handover, the application of MNIS under cloud computing can significantly shorten the handover time of surgical patients, improve the standardized rate of surgical safety verification execution and the qualified rate of nursing documents, while the rate of standardized application of prophylactic antibiotics is also significantly higher than that of the control group. The questionnaire survey of nursing staff in the operating room showed that clinical nursing staff was generally satisfied with the clinical application of MNIS under cloud computing, with an average satisfaction score of 64.5 to 11.3, and an average score of 3.58 to 0.54 for each item. Among them, pre-application training of MNIS, departmental support for MNIS, and its ease of verification in surgical patients were the three main factors favoring the clinical application of MNIS in the operating room with cloud computing, while barriers to wireless network connectivity, inconvenient PDA input, and small screen size were the three main drawbacks affecting its application. The determined clinical evaluation index system of MNIS in the operating room is innovative, which not only includes clinical care indicators but also covers general hardware and software indicators, which can effectively reflect the practical application capability of mobile terminal clinical and user experience feelings, and the evaluation index system is comprehensive.

Use and Disuse of Technology Among Persons With Memory Concerns and Their Caregivers During the COVID-19 Pandemic

Social distancing and shelter-in-place orders designed to curb the spread of COVID-19 increased isolation among persons with memory concerns (PWMC) and increased the burden on individuals providing their care. Technology, such as smartphones or tablets, has demonstrated potential to improve the social connections and mental health of older adults; however, older adults historically have been reluctant to adopt new technology. We aimed to understand why some PWMC and their caregivers used new technology to adapt to lifestyle changes during the COVID-19 pandemic while others did not. In this study, we used data collected in 20 qualitative interviews from June to August, 2020 with PWMC and their family caregivers to assess changes in and barriers to technology use. Qualitative thematic analysis identified three themes which explained motivations for using new technology during a pandemic: 1) seeking relief from caregiver burden, 2) alleviating boredom, and 3) maintaining social connection. Results further revealed lingering barriers to PWMC and caregiver adoption of technologies, including: 1) PWMC dependence upon caregivers, 2) a lack of familiarity with technology, and 3) difficulties using technology. This in-depth investigation suggests that technology has the ability to provide caregivers relief from caregiving duties and provide PWMC with more independence during periods of pronounced isolation

On Data and Care in Migration Contexts

The commentary provides the reader with several genealogies of data and care, key themes that underpin the theorisation, as well as the methodological and ethical operationalisation of a more caring digital migration studies described in this book. By doing that, it shows how pursuing careful data engagement allows understanding and reflection on the “ambivalence and shifting tensions” inherent in care-technology relations. The genealogies discussed show how neither migration nor data nor care are singular totalities but co-exist with limits and paradoxes. This is furthermore important when a caring perspective on data in migration studies is more and more relevant. This relevance is seen as a response to the recent trend of seeing migration as a laboratory where experiments with big data can be conducted and the overarching data ideology that depicts migrations as something that can be controlled through more or better data without having to come to terms with underpinning large-scale historical, socio-cultural, geo-political and economic concerns.

Improving Access to the Glycated Hemoglobin Test in Rural Communities With Point-of-Care Devices: An Application Study

Background: Living in a rural or remote area is frequently associated with impaired access to health services, which directly affects the possibility of early diagnosis and appropriate monitoring of diseases, mainly non-communicable ones, because of their asymptomatic onset and evolution. Point-of-care devices have emerged as useful technologies for improving access to several laboratory tests closely patients' beds or homes, which makes it possible to eliminate the distance barrier.Objective: To evaluate the application of point-of-care technology for glycated hemoglobin (HbA1c) estimation in the assessment of glycemic control and identification of new diagnoses of diabetes in primary care among rural communities in a Brazilian municipality.Materials and Methods: We included individuals aged 18 years or older among rural communities in a Brazilian municipality. From September 2019 to February 2020, participants were assessed for anthropometrics, blood pressure, and capillary glycemia during routine primary care team activities at health fairs and in patient groups. Participants previously diagnosed with diabetes but without recent HbA1c test results or those without a previous diagnosis but with random capillary glycemia higher than 140 mg/dL were considered positive and were tested for HbA1c by using a point-of-care device.Results: At the end of the study, 913 individuals were accessed. Of these, 600 (65.7%) had no previous diagnosis of diabetes, 58/600 (9.7%) refused capillary glycemia screening and 542/600 (90.7%) were tested. Among tested individuals, 73/542 (13.5%) cases without a previous diagnosis of diabetes, were positive for capillary glycemia. Among positives, 31/73 (42.5%) had HbA1c levels that were considered indicative of prediabetes and 16/73 (21.9%) were newly diagnosed with diabetes. Among the participants, 313/913 (34.3%) were previously diagnosed with diabetes. Recent HbA1c results were unavailable for 210/313 (67.1%). These individuals were tested using point-of-care devices. Among them, 143/210 (68.1%) had HbA1c levels higher than target levels (>7% and >8% for adults and elderly individuals, respectively.Conclusion: The application of point-of-care devices for HbA1c level measurement improved the access to this test for people living in rural or remote areas. Thus, it was possible to include this technology in the routine activities of primary health care teams, which increased the rates of new diagnoses and identification of patients with uncontrolled glycemia.

Understanding digital health ecosystem from Australian citizens’ perspective: A scoping review

Background Digital health (DH) and the benefits of related services are fairly well understood. However, it still is critical to map the digital health care landscape including the key elements that define it as an ecosystem. Particularly, knowing the perspectives of citizens on this digital transformation is an important angle to capture. In this review we aim to analyze the relevant studies to identify how DH is understood and experienced by Australian citizens and what they may require from DH platforms. Materials and methods A scoping literature review was conducted across several electronic databases (ACM Digital Library, OVID, PubMed, Scopus, IEEE, Science Direct, SAGE), as well as grey literature. Additionally, citation mining was conducted to identify further relevant studies. Identified studies were subjected to eligibility criteria and the final set of articles was independently reviewed, analyzed, discussed and interpreted by three reviewers. Results Of 3811 articles, 98 articles met the inclusion criteria with research-based articles–as opposed to review articles or white papers– comprising the largest proportion (72%) of the selected literature. The qualitative analysis of the literature revealed five key elements that capture the essence of the digital health ecosystem interventions from the viewpoint of the Australian citizens. The identified elements were “consumer/user”, “health care”, “technology”, “use and usability”, “data and information”. These elements were further found to be associated with 127 subcategories. Conclusions This study is the first of its kind to analyze and synthesize the relevant literature on DH ecosystems from the citizens’ perspective. Through the lens of two research questions, this study defines the key components that were found crucial to understanding citizens’ experiences with DH. This understanding lays a strong foundation for designing and fostering DH ecosystem. The results provide a solid ground for empirical testing.

Point-of-Need Disposable ELISA System for COVID-19 Serology Testing

A disposable enzyme-linked immunosorbent assay (dELISA) device for ate-home or doctor’s office use was developed to detect SARS-CoV-2 antibodies. Serology testing for SARS-CoV-2 antibodies is currently run using well-plate ELISAs in centralized laboratories. However, the scale of serology testing needed for epidemiological and clinical screening studies will overwhelm existing clinical laboratory resources. Instead, a point-of-need device that can be used at home or in doctor’s offices for COVID-19 serology testing must be developed and is one of four target products prioritized by the World Health Organization. Lateral flow assays are common and easy to use, but lack the sensitivity needed to reliably detect SARS-CoV-2 antibodies in clinical samples. This work describes a disposable ELISA device that is as simple to use as a lateral flow assay, but as sensitive as a well-plate ELISA. The device utilizes capillary-driven flow channels made of transparency films and double-sided adhesive combined with paper pumps to drive flow. The geometry of the channels and storage pads enables automated sequential washing and reagent addition steps with two simple end-user steps. An enzyme label is used to produce a colorimetric signal instead of a nanoparticle label in order to amplify signal and increase sensitivity, while the integrated washing steps decrease false positives and increase reproducibility. Naked-eye detection can be used for qualitative results or a smartphone camera for quantitative analysis. The device can detect antibodies at 2.8 ng/mL from whole blood, which was very close the concentration of detectable target in a well-plate ELISA (1.2 ng/mL). In this study the dELISA system was used to detect SARS-CoV-2 antibodies, but we believe that the device represents a fundamental step forward in point-of-care technology that will enable sensitive detection of many other analytes outside of a centralized laboratory.

Respawn, Reload, Relate

Games have the potential to not only entertain and immerse people, but can be used as vehicles for meaning-making. Given these qualities, games are approached as inspiration for caring technologies, especially for mental health. This transformative process often prioritises learning from games as systems, but not necessarily from the experiences of people with mental distress who play games for self-care. In this paper, we report on a participatory workshop series that sets out to further illuminate the connection between games, self-care and mental health from a humanistic, person-centred perspective. Over four workshops, we engaged 16 people with experiences of mental distress in speculative making activities and discussions of how self-care technology inspired by games could be re-envisioned. By thematically analysing our discussions and collective sense-making, we showcase how participants actively "re-frame" games for self-care. Finally, we sketch out how game developers and makers of gameful self-care technologies could build on our findings.

Neonatal innovations in resource-limited settings

In the year 2000, Millennium Declaration was signed by the world leaders to reduce the under-5 mortality rate by two-thirds from the baseline figure in 1990. Millennium Development Goal 4 was replaced by the Sustainable Development Goal (SDG) in 2015. Reduction in the neonatal mortality, which accounts for majority of the deaths in children under the age of 5 years, was an imminent goal of SDG. Despite these initiatives, the current trends in neonatal mortality are far away from the expected targets. To curb the rate of neonatal mortality, the neonatal services are expanding in India at a rapid pace. To bridge the gap between the availability and accessibility to the health care technology between the developed and developing countries, the current focus is toward the development of low-cost and effective technological innovations in neonatal care and ensuring their patenting and effective publicity. This should facilitate the translation of innovations into mass production and availability for practice with significant effect in low- and middle-income countries. Generation of evidence will increase the acceptability of these innovations by demonstrating their benefit over the currently available technologies. Fortuitously, India has developed many innovations in the neonatal health care. However, majority of the neonatologists are still unaware of the existing technological solutions, and the ways to optimally utilize them. This review is, therefore, an attempt to recognize such low-cost, effective, and sustainable innovations done in the field of neonatology, over the past few decades.