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SummarySARS-CoV-2 infection causes a wide spectrum of disease severity. Immune changes associated with severe disease include pro-inflammatory cytokine production and expansion of immature myeloid populations. The relative importance of the immunological changes in driving progression to severe disease remain poorly understood.We aimed to identify and rank clinical and immunological features associated with progression to severe COVID-19. We sought to use tests available in an on-site diagnostic hospital laboratory to identify an immunological signature for severe disease development which could be detected prior to peak severity thereby allowing initiation of therapeutic interventions. We used univariate and multivariate analysis, including unbiased machine learning, to investigate the relationships between clinical and demographic characteristics, inflammatory markers, and leukocyte immunophenotypes with progression to severe disease in 108 patients and to rank these in importance. A combination of four features (elevated levels of interleukin-6 and C-reactive protein, coupled with reduced monocyte HLA-DR expression and reduced neutrophil CD10 expression), were strongly predictive of severe disease with an average prediction score of 0.925.HighlightsSevere COVID-19 can be predicted by a combination of emergency myelopoiesis (CD10-neutrophils and HLA DR-monocytes) and inflammation (raised IL-6 and CRP)These changes can be identified from tests carried out prior to peak illness severity in a diagnostic laboratoryThis predictive model was derived from a cohort of patients with a wide range of ages, frailty and COVID-19 severityGraphical Abstract

This paper explores the construction of knowledge about ‗children‘, ‗rights‘ and ‗ECEC‘ in Irish early childhood policy discourses. This research forms part of a wider thematic research project exploring Irish early childhood policy design from a number of angles; this strand of the research is concerned with ―revealing meaning‖ from Irish ECEC policy texts through a critical discourse analysis study. The theoretical goal of a critical discourse analysis study aims to understand how specific realities have come into being in the policy area; how they are reproduced through policy literature, how language use is an integral facet of social processes, and how this shapes meaning about ECEC in wider society. The methodology used in this study follows the general rules proposed in the CDA framework devised by Chouliaraki and Fairclough (1999); alongside Foucault‘s notion that language, power and knowledge are fundamentally interconnected at the level of discourses (1977). The CDA framework was applied to policy texts using a thorough linguistic textual analysis, while also considering the wider dominant political and social context at the time of publication and dissemination. Discourses of knowledge about Irish ECEC policy have been constructed twofold; as policy responding to a ‗childcare crisis‘, and, as policy targeting educational disadvantage; both of which fall short of conceptualising services and supports as rights-based. This paper aims to show how knowledge about each concept is constructed and represented through the language used in the policy document and explore the significance of these constructs for future policy.

The Irish government have invested considerably in the broad early childhood education and care (ECEC) sector over the last decade. However, a distinction persists within Irish policy between childcare and early education, both structurally and conceptually. Early education frequently refers to intervention based pre-school services; conversely childcare frequently refers to the broad spectrum of care services for 0-12 year olds, from family based child care through to centre-based provision (Hayes & Bradley, 2006; NESF, 2005; OECD, 2004). As a result of this, ‘early childhood services in Ireland are fractured across the welfare (childcare) and educational (early education) domains and … targeted in nature’(Hayes, 2008, p. 33). The National Children’s Strategy marked ‘the beginning of a shift towards using rights-based language in policy development … by strongly reflecting the UNCRC’ (Hayes, 2002, p. 49). The ambitious language of Irish ECEC policy documents is not always realised in policy implementation, which leads to a tendency toward rhetoric. Using a children’s rights lens this paper reports on the preliminary findings of a research study which has sampled these policy documents to analyse the extent to which they consider children and are rights-based from a linguistic perspective. A critical discourse analysis (CDA), which involves thorough analysis of the linguistic structure of documents alongside wider consideration of the socio-political culture in which they were created, allows us to find ‘ways into texts’ (Pennycook, 2008). Consequently, this paper aims to use CDA to locate Irish ECEC policy, particularly it’s approach to ‘children’s rights’, in terms of language and ideology.