Rekindling hope and purpose in resource-constrained areas during COVID-19: The merits of counselling for career construction

This article reports on how the changing career counselling needs of young people during the Covid-19 pandemic can be met. It is argued that innovative and contextualised career counselling that is in line with the basic principles of ‘best practice’ and draws on a life design–based framework offers a viable conceptual framework for this kind of endeavour. Such counselling can promote young people’s adaptability; enhance their employability; and bolster their narratability, narrativity and autobiographicity. A brief theoretical overview explains innovation and contextualisation in career counselling and clarifies key aspects of counselling for self- and career construction. The style of e-career counselling advocated here can help young people make meaning of their career-lives and (re-)kindle their sense of hope and purpose. Moreover, it can help them devise practicable strategies to actuate their sense of purpose and hope and also help them experience a sense of being part of something much bigger than themselves. In addition, it can promote young people’s entrepreneurship and self-entrepreneurship and bolster their employability. Longitudinal research, including qualitative, quantitative and mixed-methods studies on the topic, is needed to examine the value of the e-career counselling approach. Such research could involve different assessment instruments and counselling strategies and include questionnaires to facilitate pre- and post-assessment of the effectiveness of the approach.

The Biden administration: changing the tide for health?

Changes and predictors of mental health of Chinese university students after the COVID-19 pandemic: A two-year study

The COVID-19 pandemic has not only affected individuals and societies physically, but has also resulted in a series of mental health problems, given the course of the disease, the speed at which it spread, and the measures taken in response to its rapid spread. Many studies have reported that hope can be an important factor in mitigating the mental health impacts of the pandemic. The present study aims to identify the factors affecting hope during the pandemic. The dataset of the study is the microdata from the Life Satisfaction Survey obtained from the Turkish Statistical Institute. This survey is conducted by an official institution. The sample size of the study is designed to produce estimates on a Turkish basis and the sampling method is a two-stage stratified cluster sampling. 20,176 people were included in the study. For the a priori analysis of the dataset, chi-square independence tests were used followed by binary logistic regression and binary probit regression models from discrete choice models. As a result of the study, it was determined that age, marital status, education level, satisfaction with income level, income change, welfare level, debt status, happiness level, satisfaction with health services, satisfaction with health, satisfaction with education, satisfaction with social life, satisfaction with personal care, feeling safe, environmental awareness, being involved in religion, and experiencing gender pressure are effective on individuals' hopes for their future. It has been determined that individuals with a positive socioeconomic level, who do not experience gender pressure, who can spare time for personal care, who are satisfied with health services, who are healthy, who are happy, who have environmental awareness, who feel safe in the region they live in, who are satisfied with the education they receive, and who are satisfied with their social life are more hopeful about the future. Among these factors, happiness level, welfare level, and feeling safe were found to be strong predictors of hope. Addressing the factors that positively affect individuals' hopefulness for the future, particularly by decision-makers and policymakers, will contribute to the establishment of a better social structure.

Research Question The COVID-19 pandemic has highlighted the need for a transformative perspective on the role of sport brands in promoting fans’ psychological well-being. Drawing upon attachment theory, the current research explores how individuals’ involvement with sport brands may contribute to their psychological well-being in the wake of COVID-19. Research Methods Data were collected from sport fans (n = 770) in mainland China through an online survey. Machine learning-based model selection algorithms were used to optimize the balance between the predictive power and parsimoniousness of the empirical model. Bayesian structural equation modeling was performed to examine the effects of sport brand involvement (SBI), crisis management performance, and perceived togetherness (PT) on fans’ sense of hope and emptiness. Results and Findings The results indicate that fans’ involvement with sport brands was positively associated with fans’ psychological well-being. SBI mitigated fans’ perceived emptiness. This relationship was partially mediated by PT but not by crisis management performance. Furthermore, sport brands’ crisis management performance and PT fully mediated the positive relationship between SBI and hope. Implications This research contributes to theorizing the transformative role of sport brands in enhancing fans’ psychological well-being. We offer an alternative view of sport branding literature by moving beyond fans’ contributions to business outcomes to explore how sport brands may benefit fans’ well-being. Findings highlight the importance of the transformative power of ‘we’ in unifying sport brands and fans amid the uncertainty of the COVID-19 pandemic.

Editorial: Special Issue: Cypriot Journal of Educational Sciences 2022

Background 
 Fundamental changes in the world of work are leaving many workers insecure and uncertain about their future. The situation is aggravated by the Covid-19 pandemic, which has resulted in billions of job losses globally (Bureau of Labor Statistics, 2020). According to the International Labor Organization (ILO, 2020), approximately 1.6 billion people in the informal sector are among those who have lost their jobs. This has led to greater uncertainty in occupational contexts, which have already been unsettled by increasing job changes (Hooley et al., 2020; Kelly, 2020). Work environments are no longer able to ‘hold’ (Winnicott, 1965) workers, leaving them insecure, traumatized, and without any sense of meaning and purpose in their work-lives. Numerous changes in the workplace (largely the effect of technological advances) have compelled workers to reconsider, reconstruct, and redesign their lives to improve their chances of finding sustainable, decent work (Di Fabio & Maree, 2016; Duarte & Cardoso, 2015; Guichard, 2018; Hartung, 2016, 2018, 2019; Ribeiro, 2016; Rossier, 2015a, 2015b; Savickas, 2007, 2019; Savickas & Savickas, 2020; UN, 2016).
 Workers have to contend with major occupational transitions (Savickas et al., 2009) requiring career counseling theorists, practitioners, researchers, and policy-makers to reconsider their theoretical and conceptual approaches and, accordingly, the practice of career counselling as a whole (Savickas et al. 2009). It serves no purpose to continue drawing on career counseling approaches and traditions that have lost their currency in today’s postmodern occupational world (Savickas & Savickas, 2019). What is needed is innovating and updating career counseling so that it can help people link career choices to a mission (personal meaning in the workplace) and a vision (social meaning of people’s work). Above all, people must be guided and counseled on which skills to master to increase their adaptability and employability (Hartung & Cadaret, 2017). This will then enable them to manage repeated work-related transitions more successfully (Sensoy-Briddick & Briddick, 2017).
 In summary: Career counseling clearly needs to come up with a practicable, theory-driven way of promoting career counseling in primary, secondary, and tertiary education – an approach that can serve as “a general rubric that covers a myriad of interventions and services” (Savickas, 2015, p. 129). At the heart of such an approach is the elicitation and implementation of ‘subjective’ aspects (‘stories’) as well as ‘objective’ aspects (‘scores’) of career counseling in education (Maree, 2013, 2020; Savickas, 2019). An approach that can encourage workers and prospective workers to choose and construct careers and design themselves successfully (Guichard, 2005, 2009; Savickas, 2019, 2020). It should also provide a platform for reconceptualizing and redesigning career counseling interventions to meet the challenges discussed above. Such an approach will enhance people’s (critical) self-reflection, reflexivity (meta-reflection), embracement of change, and conversion of aspiring intention into experienced action (moving forward) (Maree, 2020; Savickas, 2019, 2020; Savickas, 2020, in Arthur, 2020). Ultimately, it should help all people who are willing and able to work to acquire work-life identities that will enable them to recognize and use the opportunities contained in challenges to survive and flourish in these unstable times (Savickas, 2007; Savickas, 2020, in Arthur, 2020).
 Typical research questions could include the following: How can career counseling in education
 
 help worker-seekers take responsibility for their own future, become resourceful and adaptable, and manage repeated transitions in a rapidly changing world of work?
 be updated in terms of theory and praxis to promote decent work and sustainable development for all who are able and willing to work?
 be reconfigured to promote success in the workplace by increasing workers’ adaptability, employability, and career resilience?
 be used to help prospective workers clarify their career(-life) identity, make the most of change, and promote self-reflection, reflexivity, and life design?
 be provided in group contexts to promote people’s sense of meaning, rekindle their sense of purpose in the workplace, and foster their sense of critical consciousness (Blustein, 2015)?
 
 We (the editorial board) received several provocative and constructive contributions that covered a broad spectrum of research methodologies. They also covered theoretical as well as practical issues and reported on research from a quantitative, a qualitative, a mixed-methods, and an integrative qualitative-quantitative perspective.
 As always, this issue includes diverse contributions in terms of gender and race and national, international, and interdisciplinary standpoints. Individually and collectively the contributions shed light on issues underlying the renewal of career counseling in education.
 What Can Readers Expect in This Issue?
 In the leading article, Using My Career Story to foster reflective capacity, hope, and narrative change, Santilli and Hartung (2022) describe the development and use of the My Career Story (MCS) approach. This self-guided autobiographical workbook is designed to help people across the lifespan and diversity continuum articulate and shape their career-life stories. The authors discuss the outcomes of a research project where the MCS was used with young adults in Northern Italy. The findings confirmed the trustworthiness and validity of the instrument in their research context. The research participants had moved towards more action-oriented, more positive, and more lucid language in their stories by the time they had reached the end of the intervention and once they had constructed their life portraits (compared to the stories they had recounted at the outset of the intervention). The participants also achieved better scores on measures used to assess reflective capacity and hope after the intervention. The need for an approach such as that discussed in the article has never been greater – readers working in the fields of career guidance, career education, and career counseling should find the article of great value.
 In the second article, Countering master narratives with narratives of persistence: A liberation perspective in career counseling, Briddick and Briddick (2022) deal with a highly topical matter. The authors argue that many youths today have to contend with discrimination and marginalization in their daily lives, despite global efforts to eliminate such evils in society. Discrimination here is often based on youths’ (social) identities and related power systems and subjugation (Brewster & Molina, 2021). The authors add that minoritized youths especially are caught in the trap of culturally contrived ‘master narratives’ that maintain the privilege systems in their own countries (Liu, 2017). The authors maintain that reflecting carefully on such ‘master narratives’ can facilitate a key initial step in career counselling interventions with marginalized youths. The authors advocate an innovative and practicable strategy based on narrative counselling and related constructs aimed at disassembling ‘master narratives’ and providing space for the construction and enactment of ‘alternative’ stories of hope and purpose-filled futures for marginalized youths. This article, too, is a ‘must read’ for all career counsellors.
 In the third article, Life design group-based intervention fostering vocational identity, career adaptability, and career decision-making self-efficacy, Cardoso et al. (2022) examine the process and outcome of life design group intervention with Grade 9 participants. Using a quasi-experimental, mixed-methods design, the researchers investigate the effect of the intervention on the participants’ vocational identity, career adaptability, and career decision-making self-efficacy. The outcomes confirm the effectiveness of the intervention in respect of the above features as well as in advancing the participants’ reflexivity, their sense of direction and, ultimately, the construction of their careers and themselves. The research outcomes are consistent with previous findings on the topic. Researchers involved in this kind of intervention should find the article most illuminating.
 In the fourth article, Revitalising career counseling for sustainable decent work and decent lives: From personality traits to life project reflexivity for well-being, Di Fabio et al. (2022) maintain that people are increasingly being confronted with critical life and professional challenges and having to take personal responsibility for their career-life stories. The authors argue that to remain relevant career counseling requires revitalized views on counseling interventions. The authors administered the Big Five Questionnaire, the Life Project Reflexivity Scale, and measures of hedonic and eudaimonic wellbeing to University of Florence students. They then analyzed the research results by considering the relationship between life project reflexivity (LPR) dimensions and wellbeing (while controlling for the ‘Big Five’ personality traits). ‘Authenticity’ emerged as the strongest of the three LPR dimensions. The authors conclude by advocating an innovative, strengths-based prevention strategy for providing sustainable decent work and constructing meaningful life trajectories. A study well worth considering in the context of rapidly changing work and career counseling contexts
 In the penultimate article, Precariousness in the time of COVID-19: a turning point for reforming and reorganizing career counselling for vulnerable workers, Di Fabio and

Telepractice has existed for decades, but as a result of the COVID-19 pandemic, it gained value and increased desirability across the disability service and health sectors, as a mitigation strategy for the viral transmission risk. The increased desirability of telepractice encouraged organisations to invest and correspondingly enhance access to services delivered remotely via digital technology including allied health therapy interventions. The investment and uptake of telepractice provided greater learning opportunities and ability to investigate telepractice implementation in specific contexts such as disability services, enabling service providers the ability to tailor to specific population needs.MethodsThis study investigated the experience of telepractice implementation during the COVID-19 pandemic from 13 allied health clinicians and managers of disability organisations across Australia between November 2021 and February 2022. A contextualist and critical realist theory was applied through the study, with reflective thematic analysis used as the data analysis method and findings described using a metaphor method centring on diamond formation. The method selection aimed to produce findings grounded in qualitative methodology and methods while remaining accessible to the disability community.ResultsAn exploration and analysis of the data by the authors identified six themes addressing the experiences of participants and used the metaphor of diamond formation to describe changes in allied health clinicians and disability organisations during the COVID-19 influenced telepractice implementation.ConclusionThe allied health clinicians and managers who participated in this study demonstrated an overall sense of hope that telepractice would be a viable and sustainable delivery pathway for services in the future. This article endorses the integration of a planned telepractice delivery pathway that capitalises on the momentum created by the COVID-19 pandemic in a purposeful and accessible way that looks to enhance rather than replace current practices.

The Qur’an carries many references to the created world being subjected to divine testing. It, therefore, seems obvious to ask whether the COVID pandemic that has caused so much suffering across the world and continues to ravage communities represents a test by God for faithful believers. Tests can be daunting experiences, causing apprehension and fear. To what extent should faithful believers regard the COVID pandemic as a fearful, traumatic experience? On the other hand, how can believers find ways to focus on a sense of hope in the midst of the current troubles? This paper will initially consider a range of responses to the COVID pandemic by religious leaders and commentators. It will then draw out Qur’an verses referred to in these responses and will engage with these verses through the lens of several Sufi commentaries, in a search for layered meanings below a surface reading of the verses concerned.

INTRODUCTION The transplant community is well-versed in ethical issues surrounding the allocation of scarce resources, but the COVID-19 pandemic has escalated moral dilemmas of transplantation far beyond simply allocation of limited donor organs. Emanuel et al1 were unfortunately prophetic in their recent NEJM article addressing the ethical principles guiding medical decisions during the COVID-19 pandemic and the associated depletion of resources. Hospital and intensive care resources are becoming severely limited in high-transmission areas, influencing decisions about who should be transplanted and affecting the availability of donated organs.2 The risk of COVID-19 transmission to donors and recipients further alters such risk considerations. Pre–COVID-19 organ allocation schemes, which are complex, transparent, and organ-specific, are by themselves insufficient to determine who should be transplanted under such conditions, particularly in resource-constrained areas. Complex ethical considerations for transplantation during such a pandemic will inherently vary greatly by country, region, and culture—and be dynamic over time, and affected by both COVID-19 disease burden and trajectory. But the broad principles of nonmaleficence, beneficence, distributive justice, and respect for autonomy must continue to guide these difficult decisions. Nonmaleficence, for example, may dictate that living donor operations be held in heavily affected areas because of the potential risk of COVID-19 infection in donors. Indeed the same concern applies to transplant recipients, whose immunosuppression may put them at increased risk of infection posttransplant. Conversely, beneficence might suggest that successful kidney transplantation could, in addition to its other benefits, prevent the need for further dialysis center visits, potentially reducing the risk of nosocomial COVID-19 transmission. From a distributive justice perspective, by contrast, programs may need to curtail certain transplant activity simply as a result of resource constraints imposed by an overwhelming pandemic disease burden. Finally, autonomy dictates that programs communicate both the known and unknown risks of COVID-19 infection—and the policies we are each enacting as a result—to their transplant patients allowing them to make informed decisions about their care. The urgent need to adapt rapidly during the COVID-19 pandemic has challenged traditional dependence on evidence-based data and peer-reviewed literature. Healthcare workers in transplantation are being asked to navigate our patients through a minefield in the absence of conventional pillars that usually guide clinical management and decisions. For treatment protocols, we traditionally rely on approaches that have undergone a thorough evaluation, testing, and review process. In the absence of such an opportunity for gradual and deliberate review, professional societies around the world have been quick to collaborate and share their global experiences,3 and the distribution of information has largely shifted to rapid, online platforms. In making decisions during this uncertain time, it is essential that our own uncertainty, lack of knowledge, and lack of prognostic ability about the pandemic disease course are recognized and factored into our risk-benefit analyses as well as our respect for the patient's autonomy. The availability of resources for transplantation is a moving target in the COVID-19 pandemic, dependent on the position of each region and country on the COVID incidence curve, and its baseline access to healthcare resources (Figure 1). While decisions must be based on available and expected resources, they must also be informed by underlying ethical values that have been and will continue to be the rationale for all our patient-care decisions.FIGURE 1.: Responses on allocation, donor/recipient criteria, and transplant activities will largely depend on the position of centers on the slope of the incidence curve. Geographic and social characteristics will also determine the height of the curve, impacting risk-benefit assessments.RECIPIENT SELECTION AND PROGRAMMATIC POLICIES In the current global snapshot,3 programs in affected areas have been remarkably consistent in distributive justice-based decisions about which patients to transplant. Their approaches begin with practical accounting for availability of essential resources such as ventilators, ICU beds, or blood products required for successful transplantation, availability of COVID-19 free facilities for the immediate posttransplant recovery period, and availability of personal protective equipment (PPE). Of course, the prepandemic starting point of available resources in each region will impact the threshold for transplantation, and there are many places that cannot consider transplantation with any additional strain on the system. After determining who can be transplanted, programs have generally addressed the question of who should be transplanted using the principle of distributive justice to maximize benefits, minimize resource utilization, and treat the highest-need patients first. Programs are also making new risk-benefit calculations by trying to best evaluate how to apply the principles of beneficence and nonmaleficence in the setting of COVID-19. Finally, allocation decisions that are made at the programmatic level often do not account for the individual patient's desire to be transplanted despite the risk of COVID-19, and therefore, risk placing autonomy behind the overriding principles of distributive justice, beneficence, and nonmaleficence. The relative weight of these factors may be influenced by the estimated position of each center and region on the COVID-19 incidence curve and relative to the available healthcare resources (Figure 1). For regions early on the ascending portion of the COVID-19 incidence curve, representing mild to moderate resource constraints, transplantation decisions are guided by anticipating future resource limitations and infectious risks and are weighted toward autonomy, nonmaleficence, and beneficence. For kidney transplantation, for example, many centers are selecting recipients with fewer comorbidities who are unlikely to require prolonged hospitalization or the need for ICU beds. This resource-distribution strategy favors patients likely to benefit from transplantation while utilizing fewer resources and minimizing the risk of nosocomial recipient COVID-19 infection. Other programs have favored reliance on nonmaleficence as the driving principle of kidney transplant allocation because precise risks and benefits of kidney transplantation in this setting remain both highly dynamic and poorly characterized. Patients with end-stage renal disease, for example, may survive for many years on dialysis, albeit with less quality of life and longevity than following successful transplantation. Given the alternative of dialysis, many programs globally have suspended kidney transplantation based on this principle, reasoning that transplantation in the midst of the COVID-19 pandemic may do more harm than good. Several assumptions underpin this decision: that harms may indeed be great if COVID-19 infection is transmitted by an infected donor or acquired by the recipient in hospital or community during maximal infection, and that the incidence and outcomes of COVID-19 infection are less frequent and less lethal among dialysis patients than kidney transplant recipients. Given the potential for the pandemic to run a protracted and potentially recurrent course, testing the validity of these assumptions through research will be a priority. Similarly, using the considerations of maximizing benefit, minimizing risk and limiting resource use, simultaneous pancreas/kidney transplants have been suspended by many programs, based on the length of anticipated hospitalization and the likelihood of readmission in hospitals that may be filled to capacity, with high potential risk for COVID-19 exposure. Programs suspending simultaneous pancreas/kidney transplants have decided that the risks of infection and resource utilization outweigh the potential benefits of transplantation, making a decision based on both distributive justice and nonmaleficence. A unique consideration focused on beneficence and nonmaleficence is an assessment of whether the intended recipient can effectively quarantine after discharge. This makes social considerations all the more pressing in transplant selection, but importantly, while such postdischarge social distancing and quarantine considerations are critical in selection, it is essential that these considerations do not disadvantage certain categories of patients who are already vulnerable. During this challenging COVID-19 era of decreased medical resources, we must maintain a particular focus on disadvantaged populations to ensure equal access to medical care. Programs should also strive to help support social distancing, whether by reducing clinic visits or blood draws, promoting telehealth opportunities where available, or coordinating social and community support mechanisms. As COVID-19 disease burden increases (moderate-severe resource burden, Figure 1), many centers have shifted their ethical framework toward distributive justice considerations, focusing on more urgent patients in greatest need. For example, some programs have limited liver transplantation to candidates with Model for End-Stage Liver Disease (MELD) scores reflective of poor 3-month survival without transplantation, heart transplantation for intermediate- and high-risk patients, and lung transplantation for unstable patients. Of note, some regions have also seen the beneficial effects of public health interventions with flattening the disease incidence curve (dotted line, Figure 1). In these regions, decisions about which patients to transplant may differ from those in regions at a similar level of resource-deprivation but on a different trajectory. Thus, real-time assessment, not just of resources on hand but also estimated disease trajectory, is essential in appropriate planning for all such ethically guided considerations. As the incidence for COVID-19 increases and the resource burden from infectious disease alone approaches the critical threshold of consuming the entire capacity of the system (Figure 1, critical burden), programs shift their distributive justice considerations from urgent to only emergent transplants. At this point, transplantation is limited to only the most emergent cases (ie, fulminant liver failure, highest acuity heart transplantation, and decompensated patients for lung transplantation), and above this threshold, all transplantation is held based on an absolute lack of resources including ventilators, blood products, and PPE.2 At this point care systems are forced to make the most difficult decisions about which patients have claim to limited resources. While it might seem natural to shift all resources to COVID-19, this strategy disadvantages other patients with equally life-threatening conditions, such as end-organ failure. It is, therefore, essential that the sickest transplant patients continue to be considered in resource-allocation schemes because of their equal need for medical care as compared to critically ill COVID-19 patients. Encouragingly, as COVID-19 incidence has begun to decline in some geographic areas, transplant centers in these regions appear to be cautiously resuming practices from the pre–COVID-19 era. Centers and regions emerging from the pandemic will have to determine how to gradually resume transplants in a graded fashion based on capacity, resources, and considerations of other patient needs—as well as factoring in the possibility of COVID-19 recurrence, with bimodal or even multimodal incidence curves. We expect that overall operative volumes will also increase given the backlog of elective and urgent procedures, so the needs of transplant patients will have to be balanced with other patients requiring time-sensitive intervention (eg, cancer, cardiac, or vascular patients). Thus, there will likely be continuing constraints on operating room capacity. In turn, this will influence when and how full transplant activity, and living donation in particular, can be reinstated. It is becoming increasingly clear that resumption of transplant practices (and all medical practices) will be contingent on availability of COVID-19 testing for donors, recipients, and healthcare practitioners. While the availability for testing that includes a detection of COVID-19 nucleic acid or antibodies has improved in some but not all geographic areas, the sensitivity and specificity of these tests still vary. Programs will have to apply distributive justice principles for scaling up volume, determining whether to focus on maximizing benefit while minimizing resource use. They will also have to continue to evaluate the risk of COVID-19 infection in recipients as new data emerges on therapeutics, outcomes in transplant patients, and testing capabilities to make accurate judgments based on beneficence and nonmaleficence. DONOR ACCEPTANCE AND CONSIDERATIONS Decisions to accept organs from deceased donors have also been significantly affected by the COVID-19 pandemic. Many centers have been hesitant to use marginal/extended criteria grafts, believing these transplants are more likely to result in delayed function and increased resource utilization. Many centers also require donor and recipient testing for COVID-19 before organ offer acceptance.3 In addition, donor procurement operations are frequently being done by local surgeons rather than travel teams when possible to decrease the risks of exposure. As a result, some programs, particularly those that commonly perform their own donor operations, may be hesitant to accept offers because of the inability to assess the donor organs in person. The risks of prolonged hospitalization and increased resource utilization associated with extended criteria grafts are taking precedence over the risk of organ failure. Further, where resources are constrained at recipient hospitals, it is likely that the same will be true at donor hospitals. In this setting, centers and healthcare systems need to determine if those resources being used for donor care—ICU beds, nursing care, PPE, medications, and operating room time—are needed for the care of other patients. If so, their use for donor care may be in conflict. Donors are normally prioritized for such resources because a single donor can save multiple lives, and the donor often occupies those ICU resources for only a short time. As recipient operations are curtailed to only those in greatest need during this pandemic, the ability of a single donor to acutely save multiple lives becomes all the more evident. Thus, if resources permit the continued transplantation of recipients in acute need, donor care should be prioritized wherever possible because of the potential to maximize lives saved during the pandemic. Allocation of organs should be done as expeditiously as possible to minimize the burden of donor care on the system. Similarly, as resources become constrained, procurement organizations may need to become more selective in donor workup, and prioritize only those donors healthy enough to provide multiorgan donation. Ultimately, as resource constraints become critical, difficult decisions may need to be made by each center, including even halting deceased-donor care and procurement—but knowing that this also means losing the supply of life-saving organs and recognizing that critically ill transplant patients have an equally legitimate claim to scarce resources when compared to critically ill COVID-19 patients.1 Living donation is also being evaluated differently in COVID-19 affected regions. As the regional incidence of COVID-19 increases and resources necessary for safe transplantation are depleted, many centers have stopped living donation related to the risks of exposing healthy donors to COVID-19 during their hospitalizations, and due to the potential risk for asymptomatic donor disease transmission to recipients. In these decisions, nonmaleficence is taking precedence over autonomy, meaning that the risk of harm is perceived to be too great to offer the option of living donation to individual potential donors. To decrease the risk of harm, donor and recipient COVID-19 testing are necessary for any center continuing to perform living donation in this era. In areas of high prevalence, even these measures may be insufficient for harm mitigation, given the nonzero risk of nosocomial infection and the nonzero false-negative rate of testing. TRANSPARENCY AND COMMUNICATION Organ supply has run behind demand for decades. Allocation has thus traditionally been based on transparent and clear communication providing patients, providers, and the community with a framework on how to deal with fair distribution of a scarce resource. While the current crisis has not changed national allocation systems, the allocation decisions about which patients to transplant have shifted to regional and program levels. These decisions utilize different material principles of distributive justice, depending on the status of that region and its position on the COVID-19 incidence curve. Because programs are constantly adapting to the changing environment, decisions about which patients will be considered for transplantation will continue to evolve, making it all the more important to assure continuing public and patient confidence in the system with transparency and consistency. For those centers that decide to systematically pause or alter the transplantation patterns of certain waitlisted patients, centers should officially notify their patients. This approach has been selected by some institutions particularly for simultaneous kidney/pancreas, pancreas after kidney, or pancreas alone transplants. As most centers have applied more nuanced center-specific modifications to donor and recipient criteria, it is also important to update patients and providers on these developments as they occur. Such communication should provide clear information on temporary changes to selection and allocation approaches, in a language facilitating general insight on the reasons behind these decisions. Moreover, programs must determine the best way to communicate both the known and unknown risks of COVID-19 infection with patients who are being considered for a transplant so that patients can make informed decisions consistent with their personal goals and values. Clear communication with waitlisted patients about programmatic changes during the shifting risk-landscape of the COVID-19 pandemic will allow transplant programs to maintain respect for patient autonomy as well as patient trust during this critical time. Transparency in communication is not only critical for the trust and effective flow of information between providers and patients but also between government healthcare agencies and transplant providers. Accurate reporting of the incidence of COVID-19, real-time and realistic appraisals of the current and expected availability of resources, and effective strategies to alter the course of the pandemic should be shared across regions within and between countries. COVID-19 does not recognize borders or discriminate between countries and continents, and this pandemic has demonstrated unequivocally that global cooperation is imperative to blunt its devastating impact. As one such mechanism for facilitating international collaboration and coordination, The Transplantation Society is currently providing an online dashboard of up-to-date global information and experience in response to the crisis (https://tts.org/covid-19). CONCLUSIONS The same ethical principles that have always been used to guide transplant practices continue to apply during the COVID-19 era, but the balance between autonomy, beneficence, nonmaleficence, and justice will be inherently fluid, dependent on baseline resources, local practices, and where a given region resides—and is headed—on the COVID-19 incidence curve (Figure 1).4 Programmatic decisions about transplantation will weigh more heavily on distributive justice, beneficence and nonmaleficence than respect for autonomy. The overriding material principle of distributive justice will change, and be weighted more or less heavily, throughout the stages of the incidence curve based on available resources. Beneficence and nonmaleficence calculations must be continually reassessed as more data become available regarding the risk of COVID-19 infections in transplant patients, the availability and accuracy of testing, and the efficacy of new therapeutic modalities. While the complexity, threats, and consequences of COVID-19 are immense, it is reassuring to see the transplant and medical communities rallying together in such a time, and to see, as a result, such thoughtful and consistent responses to dealing with this situation around the globe. Putting aside the jargon of classical medical ethics, these global responses reflect the straightforward principles of doing the right thing for our patients, at the right time, for the right reasons.

Transformational leadership is one of the most widely discussed and utilized notions that has risen to the forefront of educational administration. Transformational leadership was initially conceived of as a process whereby leaders strategically transform the system or organization to a higher level by increasing the achievement and motivation of their followers. Early theorists would also argue that transformational leadership and change are inexorably intertwined, which in turn underscored the importance of a leader’s ability to positively transform the attitudes, norms, institutions, behaviors, and actions that structure our daily lives. Later writers and researchers would gradually extend and develop the theory and argue that the goal of transformational leadership is to transform people as well as organizations. Early work on transformational leadership concentrated on politics, business, and the armed services, and the research emphasized the value of “followers” as a distinguishing factor present in the transformational leadership model. This distinction is likely what led scholars to apply its tenets to modern educational contexts, which are typically characterized by significant pressures to implement widespread reforms and change. In this regard, transformational leadership is often viewed as well suited to education as it empowers followers (i.e., instructors) and provides them with a sense of hope, optimism, and energy and defines the vision of productivity as they accomplish goals. Additionally, transformational leaders work toward influencing shared beliefs and values to create a comprehensive level of change and innovation and aim to nurture a school culture that is oriented toward a learning ethos, whereby such leaders seek to expand the capacities of each employee, enhance their ways of thinking, and promote individual ambition. In this way, learning and growth becomes a shared responsibility. Transformational leadership has garnered significant attention and popularity. However, when viewed from a globalized and cross-cultural perspective it raises significant questions regarding generalization. One key question in the literature surrounding transformational leadership is whether the concept can be applied across national and organizational cultures. Theoretical education debates often focus on transformational leadership’s reliability and viability within educational environments, especially regarding how such environments define and handle change, organizational learning, institutional effectiveness and improvement, and enhancing student outcomes.

Understanding membrane traffic from molecular ensemble, energetics, and the cell biology of participant components

COVID-19: where do we go from here?

BackgroundOn March 17, 2020 an expert ASRM task force recommended the temporary suspension of new, non-urgent fertility treatments during an ongoing world-wide pandemic of Covid-19. We surveyed at the time of resumption of fertility care the psychological experience and coping strategies of patients pausing their care due to Covid-19 and examined which factors were associated and predictive of resilience, anxiety, stress and hopefulness.MethodsCross sectional cohort patient survey using an anonymous, self-reported, single time, web-based, HIPPA compliant platform (REDCap). Survey sampled two Northeast academic fertility practices (Yale Medicine Fertility Center in CT and Montefiore’s Institute for Reproductive Medicine and Health in NY). Data from multiple choice and open response questions collected demographic, reproductive history, experience and attitudes about Covid-19, prior infertility treatment, sense of hopefulness and stress, coping strategies for mitigating stress and two validated psychological surveys to assess anxiety (six-item short-form State Trait Anxiety Inventory (STAl-6)) and resilience (10-item Connor-Davidson Resilience Scale, (CD-RISC-10).ResultsSeven hundred thirty-four patients were sent invitations to participate. Two hundred fourteen of 734 (29.2%) completed the survey. Patients reported their fertility journey had been delayed a mean of 10 weeks while 60% had been actively trying to conceive > 1.5 years. The top 5 ranked coping skills from a choice of 19 were establishing a daily routine, going outside regularly, exercising, maintaining social connection via phone, social media or Zoom and continuing to work. Having a history of anxiety (p < 0.0001) and having received oral medication as prior infertility treatment (p < 0.0001) were associated with lower resilience. Increased hopefulness about having a child at the time of completing the survey (p < 0.0001) and higher resilience scores (p < 0.0001) were associated with decreased anxiety. Higher reported stress scores (p < 0.0001) were associated with increased anxiety. Multiple multivariate regression showed being non-Hispanic black (p = 0.035) to be predictive of more resilience while variables predictive of less resilience were being a full-time homemaker (p = 0.03), having received oral medication as prior infertility treatment (p = 0.003) and having higher scores on the STAI-6 (< 0.0001).ConclusionsPrior to and in anticipation of further pauses in treatment the clinical staff should consider pretreatment screening for psychological distress and provide referral sources. In addition, utilization of a patient centered approach to care should be employed.

COVID-19 has brought about many changes for rural families, affecting their family roles, childcare responsibilities, financial status, and experiences of family stress. In this study, I examine (1) how rural grandparents and their adult children perceive family stress related to their family roles and responsibilities during COVID-19 and (2) how rural grandparents and their adult children have coped with the stress of family roles and responsibilities during COVID-19. Data comes from 44 in-depth interviews. The findings of this study suggest that COVID-19, a family stressor, has been the source of stress among rural grandparents and their adult children. The findings suggest that families adapted through a range of improvised strategies such as relocating, abstaining from employment, taking on additional childcare, and adjusting personal identities to maintain stability during uncertainty. These adaptations were not merely practical but often guided by moral and faith-based reasoning, allowing participants to maintain agency despite constraints. Before the COVID-19 pandemic, grandparents played a significant role in childcare, sometimes to the point of being the primary childcare providers (Harrington Meyer 2014). COVID-19 has further complicated the roles and responsibilities of rural grandparents and their adult children. COVID-19 brought changes to rural families, particularly in the areas of their employment, family roles and relationships, childcare responsibilities, and sense of hope.