Changing the World for Children with Complex Feeding Difficulties: Cultural-Historical Analyses of Transformative Agency

How to bring about positive change is a key concern in cultural-historical theory. There is an urgent imperative to address questions of transformation at the nexus of the individual and the social. One way to approach this is through the concept of agency, the means through which people go beyond coping with problems or adapting to the status quo, instead striving to make the future that ought to be a reality. This paper takes up ideas from Stetsenko’s transformative activist stance (TAS), Sannino’s transformative agency by double stimulation (TADS), and Edwards’ relational agency, tracing the emergence and enactment of agency among parents of children with complex feeding difficulties. These children were unable to eat orally, instead using a tube to feed. Each family strived towards, and realised, futures where their child was able to feed orally, without a tube. Parents acted agentically in ways that were contingent upon relevant cultural tools. Such tools are key to futures that are more inclusive, equitable and nurturing for all children and their families. The paper highlights the value of contemporary cultural-historical approaches to agency in understanding and provoking transformation at the nexus of the individual and social.

Regional Mechanical Thrombectomy Imaging Protocol in Patients Presenting with Acute Ischemic Stroke during the COVID-19 Pandemic

BACKGROUND AND PURPOSE

Chest CT is a rapid, useful additional screening tool for coronavirus disease 2019 (COVID-19) in emergent procedures. We describe the feasibility and interim outcome of implementing a modified imaging algorithm for COVID-19 risk stratification across a regional network of primary stroke centers in the work-up of acute ischemic stroke referrals for time-critical mechanical thrombectomy.

MATERIALS AND METHODS

We undertook a retrospective review of 49 patients referred to the regional neuroscience unit for consideration of mechanical thrombectomy between April 14, 2020, and May 21, 2020. During this time, all referring units followed a standard imaging protocol that included a chest CT in addition to a head CT and CT angiogram to identify Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infective pulmonary changes.

RESULTS

Overall, 2 patients had typical COVID-19 radiologic features and tested positive, while 7 patients had indeterminate imaging findings and tested negative. The others had normal or atypical changes and were not diagnosed with or suspected of having COVID-19. There was an overall sensitivity of 100%, specificity of 74.1%, negative predictive value of 100%, and positive predictive value of 22.2% when using chest CT to diagnose COVID-19 in comparison with the real-time reverse transcriptase-polymerase chain reaction test. The mean additional time and radiation dose incurred for the chest CT were 184 ± 65.5 seconds and 2.47 ± 1.03 mSv. Multiple cardiovascular and pulmonary incidental findings of clinical relevance were identified in our patient population.

CONCLUSIONS

Chest CT provides a pragmatic, rapid additional tool for COVID-19 risk stratification among patients referred for mechanical thrombectomy. Its inclusion in a standardized regional stroke imaging protocol has enabled efficient use of hospital resources with minimal compromise or delay to the overall patient treatment schedule.

Cardiac magnetic resonance imaging

Recent advances in technology have allowed magnetic resonance imaging to be exploited in cardiology. It is capable of giving high definition structural and functional information. The current applications of this technique and how it may develop in the future are reviewed.