Lessons from the "non-critical" patient during a pandemic: developmental-behavioural pediatric populations & COVID-19

Seemingly overnight, in March 2020, the world was turned upside down by the global SARS-CoV 2 (novel coronavirus) pandemic. As COVID-19 affected all aspects of clinical care, Canadian ambulatory clinics for any service deemed "non-urgent" or "non-critical," were suspended for several months. When outpatient care slowly resumed during the summer and fall of 2020, the backlog of patients in these areas and subsequent requests for follow-up significantly outpaced the number of available appointments. In fact, it became apparent that certain patients' needs had grown in unprecedented ways during the pandemic, even though their issues had previously been given low priority during the acute crisis period. Among these groups were youth with underlying mental health conditions, those with chronic but non-life-threatening illnesses, and the subgroups seen in Developmental-Behavioural Pediatrics. In Montréal, they were among the least likely to have their needs met as the waves of COVID-19 moved through the community, and many still struggle to find relevancy in the discussions about the hidden impacts of the coronavirus pandemic, even one year later. What can the experiences of these marginalised youth teach us about what our system labels less relevant care in the context of an acute health care crisis? A short narrative presentation will demonstrate insights gleaned from 2020 & early 2021 to underscore the often unrecognised challenges faced by these populations and their families.

The Market Lives on Death: The Endocolonizing Logic of the Fascist Moment

This article poses the question of whether what we are witnessing today can be properly described as “fascistic.” It argues that it can if we understand fascism as an attack on liberal-democracy resulting from the now chronic (rather than acute) crisis of capitalism. Like the fascism of the twentieth century, this entails an endocolonizing logic that nonetheless relinquishes its claim on a future increasingly imperilled by the nature of the Covid-19 pandemic in the context of the impending climate emergency.

Community Seed Groups: Biological and Especially Social Investigations Can Support Crisis Response Capacity

The food system is comprised of biophysical and social processes affecting everyone, and food system citizen and community science offer opportunities for research, especially on unstudied aspects of that system, including responses to crises and disasters. We describe how community science work on food crop seeds responded to the crisis of the COVID-19 pandemic, and how this response built on the social investigations that are part of that ongoing work. To address a number of the crises of the Anthropocene, groups and individuals have been creating infrastructure supporting community-driven seed research and provision. Some organizations investigate community development of locally adapted crops, and introduction of novel materials for testing in new environments, as well as alternative social organization and processes supportive of this research and aligned with their values. Looking at examples of two active, United States–based, community seed organizations, represented by two of the co-authors, we outline the values and theoretical grounding of this work, and how responding to the acute crisis of the COVID-19 pandemic has challenged these organizations to rapidly develop seed distribution work in ways consistent with their values and missions. Meeting these immediate needs has meant temporarily pivoting from the longer-term evolutionary processes of their community science biological investigations; still, existing social investigations remained relevant and useful in their pandemic work. The effectiveness of this crisis response provides an example of explicitly values-driven research, and indicates the importance of recognizing the implicit social investigations of community science that sometimes experiment with alternative approaches to organizing society to achieve both immediate results, and longer term, prosocial change.

DISTANCE FORMS OF CRISIS INTERVENTION DURING THE COVID-19 PANDEMIC

In the current pandemic period caused by COVID-19, the availability of distance forms of social services is exceedingly important. Crisis intervention performed in a distance format helps a person experiencing an acute crisis via telephone and online form of assistance. The paper's primary aim was to find out the use of distance crisis intervention services during the COVID-19 pandemic in Slovakia, to clarify what needs are prioritized for respondents at this time, the type of social problems they turn to crisis intervention and the usability of crisis lines during the pandemic. The quantitative survey was carried out in the form of an anonymous questionnaire, which was available only in electronic form via Google forms, and the respondents were addressed on social networks. The questionnaire was filled in by 291 respondents. Based on the processed data, the distance form of assistance is a little-sought option in solving social problems related to the COVID-19 pandemic. Our recommendation is to support and promote the distance form of assistance more through advertising or financial support – especially considering that many crises could not be dealt with on the part of respondents or the helplines themselves.

The Political Economy of the Profitability Crisis in Britain

This chapter provides a historical overview of the profitability crisis that undermined the postwar economic boom, gave rise to the phenomenon of stagflation, and ultimately drove the financial liberalizations explored in this book. This chapter puts forward a novel historical categorization of British stagflation, by identifying two distinct phases within Britain’s experience of the global profitability crisis. The first, from 1967 to 1977, was characterized by low rates of profit, rising inflation, and repeated current account imbalances that resulted in currency crises. The second, from 1977 to 1983, still saw low profitability and high inflation, but the rising price of sterling ensured that there were no sterling crises. The chapter then details how governments combined governing strategies of depoliticized discipline and palliation in different ways during these two periods of acute crisis in order to navigate the contradictory imperatives of global competitiveness and domestic legitimacy. Policies of financial liberalization constituted attempts to support these strategies.

PP41 British columbia emergency health services assess, see treat and refer palliative clinical pathway

Background/Research ObjectivesParamedic services have experienced a steadily increasing demand from palliative patients accessing 911 during times of acute crisis, and not wishing subsequent conveyance to ED. Early data indicates that many of these patients are NOT already connected to palliative care teams.To address this demand and to connect patients to care, BCEHS introduced the Assess, See, Treat and Refer (ASTAR)-Palliative Clinical Pathway. Objectives are to reduce patient conveyance to ED, reduce hospitalizations and improve patient care through referral after non-conveyance.InterventionParamedic activation of the ASTaR Palliative Clinical Pathway results in referral of non-conveyed palliative patients to local Home and Community Care teams and BCEHS paramedics. The referral occurs within 1-6 hours of paramedic contact and follow up occurs over the next 24-48 hours by telephone. This referral action provides safe, effective, patient-centred care for non-conveyed patients, and also fills a gap for connecting patients to local palliative care teams.ImpactA retrospective case review of 183 cases was conducted. Symptom improvement was achieved in 70% of cases, the ED non-conveyance rate was 19%, and the time on task when palliative patients were treated at home and not conveyed was 37% less (52 minutes) than if palliative patients were transported (82 minutes). All 183 patients were connected to either the local home and community care team or BCEHS Rural Advanced Care Community Paramedics (RACCP).Lessons LearnedPalliative patients frequently call 911 for help during acute crisis events and many of these patients do not wish conveyance to ED. The introduction of the ASTaR palliative clinical pathway provided safety netting and referral to appropriate care teams.

Countering misinformation and disinformation during contentious episodes in a divided society: Tweeting the 2014 and 2015 Ardoyne parade disputes

Whereas there has been much research into the manufacture of ‘fake news’ to sow disunity within liberal democracies, little is known about how information disorders affect deeply divided societies. This paper addresses that gap in the literature by exploring how digital media are used to share misinformation and disinformation during contentious public demonstrations in Northern Ireland. It does so by reviewing the literature on social media information flows during acute crisis events, and qualitatively exploring the role of Twitter in spreading misinformation and disinformation during the 2014 and 2015 Ardoyne parade disputes. Results indicate that visual disinformation, presumably shared to inflame sectarian tensions during the parade, was quickly debunked in information flows co-curated by citizens and professional journalists. Online misinformation and disinformation appeared to have minimal impact on events on the ground, although there was some evidence of belief echoes among tweeters who distrusted the information provided by mainstream media.

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers.Methods: A consecutive sample of 86 adolescents aged 11–18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents.Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI.Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.

Epilogue and Conclusion

We explore the ongoing importance of election promises since 1997. Even if the way that promises are disseminated has changed with the growing importance of the internet and social media in campaigning, expectations surrounding manifestos remain roughly those that were set during the twentieth century. And yet the Brexit controversy has arguably created an acute crisis in trust in politicians’ promises and uncertainty about the authority of election manifestos. In the aftermath of the Brexit vote, manifestos enjoyed a more central role in the 2017 and 2019 elections than they had achieved at other elections during the early twenty-first century, not least because of the ambiguities of the mandate provided by the referendum.