Introduction

A political shift to populist and nationalistic parties in the democratic countries has recently seen a move away from globalization, accelerated by a desire to contain Covid-19 epidemic within national borders together with dramatic impact on travel internationally. The development process itself may not have changed dramatically, but the advent of the Internet and changes in consumer behaviour have resulted in a remarkable shift in distribution channel and segment mix for the hotel industry;technology will continue to deliver further changes, including in methods of design and construction as well as services delivery. The ratio of flagged hotels and a shift to franchised and white label units has increased, and the nature of owners and range of investors changed to reflect the attraction of managed hotel investment in an era of low interest rates and globalization with the major branded groups' geographic reach extending dramatically, especially into China. © 2022 selection and editorial matter, Josef Ransley, Hadyn Ingram and Debra Adams;individual chapters, the contributors

COVID-19 Vaccine Hesitancy in a Developing Country: Prevalence, Explanatory Factors and Implications for the Future

Objectives Vaccine hesitancy is a public health challenge highlighted during the coronavirus 2019 (COVID-19) pandemic. This study sought to determine prevalence and explanatory factors leading to COVID-19 vaccine hesitancy in the Jamaican population to inform vaccination strategies. Study design Exploratory cross-sectional study. Methods An exploratory survey was distributed electronically between September and October 2021, to gather information on COVID-19 vaccination behaviour and beliefs among the Jamaican population. Data were expressed as frequencies and analysed using Chi-square followed by multivariate logistic regressions. Significant analyses were determined at p<0.05. Results Of the 678 eligible responses, most were females (71.5%, n=485), between ages 18-45 years (68.2%, n=462), had tertiary education (83.4%, n=564) and were employed (73.4%, n=498), with 10.6% (n=44) being healthcare workers. COVID-19 vaccine hesitancy was present in 29.8% (n=202) of the survey population, mainly because of safety and efficacy concerns and a general lack of reliable information about the vaccines. The likelihood of hesitancy increased amongst respondents under 36 years (OR 6.8, 95% CI 3.6, 12.9), those who delayed initial acceptance of vaccines (OR 2.7, 95%CI 2.3, 3.1);parents for their children and with long waits at vaccination centres. Likelihood of hesitancy decreased for respondents over 36 years (OR 3.7, 95% CI 1.8, 7.8) and with vaccine support from pastors/religious leaders (OR 1.6, 95%CI 1.1, 2.4). Conclusions Vaccine hesitancy was more prevalent in younger respondents who were never exposed to the effects of vaccine-preventable diseases. Religious leaders had more influence than healthcare workers to increase vaccine uptake.

The Preliminary Investigation on Micro-Credentials Practices in Malaysia

This COVID-19 has lately changed the way individuals study and teach by making it available at any time, from any location, and at a low cost. Traditional face-to-face teaching and learning are losing popularity as more students opt for hybrid or all-online learning. In today's fast-paced business, the advent of the gig economy needs the development of individuals and experts with specialised skill sets to fill increasingly specialised positions. Higher education providers needed a more dynamic and quick style of learning to match these demands, which Micro-Credential, a well-known player in 21st-century training and education, delivered. Micro-credentials are nanodegrees, also known as small qualifications, that demonstrate a person's talents, knowledge, and/or experience in a certain subject area or ability. After completing a micro-credentials course, the learner will receive a digital badge. The adoption of Micro-Credential courses in Malaysia was investigated using desktop research and a survey questionnaire in this study. This study examines how Micro-Credentials are used in Malaysia's top three public universities, as well as a poll of Malaysian students' Micro-Credentials habits. Micro-credentialing appears to be gaining popularity at Malaysian universities. The research will be broadened to collect and analyse data for the preliminary study, which will focus on learners' attainment of Digital Badges for Micro Credential Computing Courses using a quantitative research technique. © 2022 IEEE.

COVID-19 vaccine hesitancy in a developing country: prevalence, explanatory factors and implications for the future.

OBJECTIVES: Vaccine hesitancy is a public health challenge highlighted during the COVID-19 pandemic. This study sought to determine the prevalence and explanatory factors leading to COVID-19 vaccine hesitancy in the Jamaican population to inform vaccination strategies. STUDY DESIGN: This was an exploratory cross-sectional study. METHODS: An exploratory survey was distributed electronically between September and October 2021 to gather information on COVID-19 vaccination behaviour and beliefs among the Jamaican population. Data were expressed as frequencies and analysed using Chi-squared followed by multivariate logistic regressions. Significant analyses were determined at P < 0.05. RESULTS: Of the 678 eligible responses, most were females (71.5%, n = 485), between ages 18-45 years (68.2%, n = 462), had tertiary education (83.4%, n = 564) and were employed (73.4%, n = 498), with 10.6% (n = 44) being healthcare workers. COVID-19 vaccine hesitancy was present in 29.8% (n = 202) of the survey population, mainly because of safety and efficacy concerns and a general lack of reliable information about the vaccines. The likelihood of hesitancy increased amongst respondents under 36 years (odds ratio [OR] 6.8, 95% confidence interval [CI] 3.6, 12.9), those who delayed initial acceptance of vaccines (OR 2.7, 95% CI 2.3, 3.1); parents for their children and with long waits at vaccination centres. Likelihood of hesitancy decreased for respondents over 36 years (OR 3.7, 95% CI 1.8, 7.8) and with vaccine support from pastors/religious leaders (OR 1.6, 95% CI 1.1, 2.4). CONCLUSIONS: Vaccine hesitancy was more prevalent in younger respondents who were never exposed to the effects of vaccine-preventable diseases. Religious leaders had more influence than healthcare workers to increase vaccine uptake.

Survey instrument validation for a learner's motivation to attain digital badge for micro-credential courses: cognitive interview and validity test

COVID-19 has lately changed the way that people learn and teach by making it accessible at any time, from any location, and for a reasonable price. Traditional face-to-face teaching and learning are losing in popularity as more students choose hybrid or online mode study. The gig economy expansion in today's fast-paced business requires the cultivation of people and specialists with increasingly specific skill sets to fill increasingly specialized positions. Micro-Credential is a prominent actor in 21st-century training and education that offers higher education providers a more dynamic and quick learning style to match these demands. It is observed that learners in Malaysia are substantially new to the Micro-Credential and Digital Badge. Hence, this paper aims to present the findings on survey instrument validation in measuring the motivation of learners to attain the digital badge. The study uses a cognitive interviewing method for pre-test in validating the items of the adopted survey instrument. Then, in a pilot test, the survey instrument is again evaluated to measure the validity and reliability of the items using SPSS statistical software. The findings from the pre-test summarized the feedback and suggestions for improvements in fitting the study context and language used. The improved survey instrument undergoes a pilot test to confirm the validity and reliability of the survey items. The finalized survey instrument is then adopted for the main study with a larger sample of learners - university students, working professionals, business owners, and non-working adults using purposive sampling.

Now You See Me, Now You Don't: Exploring Medical Students' Cognitive, Emotional and Behavioural Engagement with Emergency Remote Learning During the COVID-19 Pandemic

The COVID-19 pandemic had forced medical students to study at home, transitioning to an emergency remote learning mode of instruction. Its impact on students was unknown and likely to be of concern. Therefore, this study assessed cognitive, emotional and behavioural engagements of medical students during emergency remote learning, and examined its associations with regard to their age, gender, stages of study and ethnic groups. A self-administered questionnaire was distributed to undergraduate medical students at one public medical school in Malaysia. Emergency remote learning was conducted via Microsoft Teams (synchronous) and web resources (asynchronous). The questionnaire consisted of four sections: demographic background, emotional, behavioural, and cognitive engagements with emergency remote learning. Three hundred twenty-nine students (n = 329) completed the questionnaire. The three engagement dimension scores were 3.36/4.00 (behaviour - act), 3.16 (cognition - think) and 3.07 (emotion - feel), respectively. There was a significant difference between the engagement dimension scores (paired data), implying that what students feel, think and act on emergency remote learning did not seem to align. Next, engagements of these students were not significantly associated with their age, stages of study, and ethnic groups, but male students had higher dimension mean scores for cognitive and emotional engagements. Emergency remote learning had a considerable impact on student engagements. The study calls for continuing efforts in improving effectiveness and equity in learning engagements among medical students in the post-pandemic era. © Malaysian Association of Education in Medicine and Health Sciences and Penerbit Universiti Sains Malaysia. 2022

COVID-19 Vaccine Hesitancy in the Jamaican Populace: Prevalence and Associated Factors

Objective: To assess the prevalence and contributing factors towards COVID-19 vaccine hesitancy in the Jamaican population. Method(s): Following ethical approval, an exploratory online survey was distributed electronically to derive information on COVID-19 immunization behaviour and beliefs. Data were expressed as frequencies and analysed using Chi-squared followed by multivariate logistic regressions to determine associations and contributions of various factors towards the COVID-19 vaccine hesitancy. Significant associations were determined at p < 0.05. Result(s): Of the 678 respondents assessed, 71.5% were females, 68.2% between ages 18-45 years, 83.2% obtained tertiary education and 61.2% were employed, with 10.6% being healthcare workers. Most were from urban communities (69.5%) in Kingston & St. Andrew (42.1%) and St. Catherine (31.3%). COVID-19 vaccine hesitancy was present in 29.8% of the population but the likelihood doubled with age <36 years (OR: 1.9 (95% CI: 3.6, 12.9)) and tripled in those who initially delayed acceptance of the vaccine (OR: 2.7 (95% CI: 12.3, 3.1)). Even with acceptance of the vaccine, parents were 3 times more likely to delay the vaccine for their child (OR: 2.6 (95% CI: 1.2, 5.3). Likelihood of hesitancy decreased by >6 with belief that the vaccine was safe (OR: 6.2 (95% CI: 4.8, 7.8)), for ages = 56 years (OR: 2.5, 95% CI: 1.8, 7.8), healthcare workers, higher education, and receipt of other recommended vaccines. Conclusion(s): Prevalence of COVID-19 vaccine hesitancy was 29.8%, with increased odds amongst respondents younger than 36 years, with parenthood and delayed initial vaccine acceptance. Hesitancy decreased for persons older than 36 years, for healthcare workers and with higher education and belief that the vaccine was safe.

E-Learning: Global Perspectives, Challenges and Educational Implications

As the world recovers from the unprecedented outbreak of the COVID-19 pandemic, the field of education continues to cushion the impacts of school closures and teaching disruption through various measures. E-learning, while not new, has taken a greater role in mitigating the effects of the pandemic. This book is not only a collection of chapters shared by researchers and academics but also a manifestation of the dedication of those involved in the pursuit of providing equitable and quality education through the support of e-learning tools and platforms. The book begins with an outlook on the post-pandemic potentials and challenges of utilising e-learning for cross-border education. The chapter by Donnie Adams and Chuah Kee Man focuses on the necessary measures that can be taken to fully maximise the use of e-learning in promoting cross-border education in higher education institutions. It is indeed timely for higher education institutions to re-examine the concept of cross-border education through the lens of e-learning and virtual mobility especially when physical presence is costly or not feasible. Several innovative pedagogical approaches and ideas are also presented in enhancing learning experience via e-learning. In Chapter 2, Zainun Mustafa and colleagues offered their perspectives on using creative pedagogy through e-learning for the purpose of science education. They explain the distinctive components of creative pedagogy that can be incorporated through various e-learning tools in order to foster meaningful learning in science classrooms. In Chapter 3, Vinothini Vasodavan and colleagues focus on developing students' attitude domain via online collaborative learning tools. They propose a framework which was derived through the fuzzy Delphi method. Their model serves as a guide in selecting the most suitable collaborative learning tools to develop the attitude domain of the students. In the next chapter, Selvakumar Selvarajan and colleagues introduce the concept of interactive digital storytelling assignment in online teaching and learning that could help teachers foster higher order thinking skills among their students. In addition, studies that measure the impact of online learning in different settings are also included in this book. In Chapter 5, Mustaji and colleagues reported the outcomes from their study on online learning engagement among Indonesian university students during the COVID-19 pandemic. Using Rasch model analysis, their study highlighted the Indonesian students' level of engagement and readiness in coping with online learning. In Chapter 6, Muhammad Mujtaba Asad and colleagues shared their findings on a study conducted on university students in Pakistan, which examined the challenges that they faced dealing with online learning during the pandemic. Finally, in Chapter 7, Riccardo Corrado and Audrey Liwan described massive open online courses (MOOCs) implementation in the Association of Southeast Asian Nations (ASEAN) region, specifically on the barriers faced by the member states. They also offered their review of issues to be addressed in creating a homogeneous ecosystem for MOOCs in ASEAN. © 2022 by Nova Science Publishers, Inc. All rights reserved.

Online Learning Engagement among Indonesian University Students during the COVID-19 Pandemic: A Rasch Model Analysis

The COVID-19 pandemic has caused a sudden and dramatic disruption to all levels of education. Universities all around the world have had to transition from the traditional face-to-face learning and teaching mode to the online learning mode. Indonesian universities are no exception, as online learning through the internet has become the ‘new normal’ for both educators and students. However, little is known about students’ engagement in the online mode of instruction during the COVID-19 pandemic, particularly in a developing country like Indonesia. The purpose of this non-experimental study was to investigate students’ engagement in online learning in terms of cognitive engagement, emotional engagement, and behavioral engagement. A total of 1303 public university students from Java Island, Indonesia participated in the study. Using the Rasch model analysis, the validity and reliability of the study’s instrument was established as good. The findings of the study showed that Indonesian students face difficulties adapting to full online learning. Differential item functioning (DIF) was conducted to assess students’ engagement in the online learning mode, specifically with regard to students’ demographic factors (gender and level of study), which revealed unique outcomes. The findings of this study help educators understand students’ responses to and engagement in online learning during the COVID-19 pandemic, especially in public universities in Indonesia. This study also encourages educators to reflect on their own online teaching and learning activities during the pandemic. Implications and recommendations for future research on blended learning practices are presented. © 2022 by Nova Science Publishers, Inc. All rights reserved.

E-Learning and Cross-Border Higher Education: Post-Pandemic Potentials and Challenges

The impact of COVID-19 pandemic on higher education goes beyond campus closures and disruption in programme delivery. The crisis has indirectly allowed higher education institutions to re-examine their existing programme structure in order to be more flexible and accessible to students both locally and internationally. Such need has triggered a new interest in assessing the use of e-learning in enhancing cross-border higher education, which was traditionally restricted mainly to campusbased physical experience. This chapter discusses the challenges and potentials of implementing cross-border higher education through elearning mode in the context of post-pandemic higher education ecosystem. The transition to online learning during the pandemic as faced by higher education institutions has elevated the interest in maximizing the roles that e-learning could play in higher education. While e-learning has the potential to allow more cross-border programmes to be offered internationally via virtual mobility, issues surrounding quality assurance, infrastructure and diversity remain critical to be addressed. Higher education institutions should not emphasize solely on penetrating new markets without taking measures to deal with the issues mentioned. On the whole, this chapter would serve as a good reference to relevant stakeholders in uncovering the hidden potentials of e-learning in crossborder higher education and evaluating its challenges. © 2022 by Nova Science Publishers, Inc. All rights reserved.

Bricks to Clicks: Students’ Engagement in E-Learning during the COVID-19 Pandemic

The COVID-19 pandemic has forced higher education institutions to execute mitigation efforts such as an e-learning mode of instruction to reduce the impact on pedagogical activities. These challenges have raised concerns on students’ engagement in e-learning as students are at risk of falling behind in education. However, there is little empirical research focusing on students’ engagement in e-learning experiences. The purpose of this study is to investigate students’ engagement in e-learning as well as specifically assess their engagement based on gender, age, ethnicity, level of education and field of study in a Malaysian public higher education institution. This study used a non-experimental quantitative research design. Data were collected from a sample of 281 students using the Blended Learning Engagement Questionnaire©. WINSTEPS Rasch model measurement software was used to determine the reliability and validity of the research instrument. Subsequently, Differential item functioning (DIF) was conducted to assess students’ engagement in e-learning as well as specifically assessing student’s demographic factors such as gender, age, ethnicity, level of education and field of study. Findings indicate students have high levels of behavioural engagement as compared with cognitive and emotional engagement in e-learning. Further analysis indicated there were differences in students’ engagement based on demographic factors such as gender, age, and field of study. This study provides insight into students’ engagement in e-learning that will help lecturers to reflect on their own teaching practices. Implications and recommendations for future research are presented. © Penerbit Universiti Sains Malaysia, 2021.

Randomized, Multi-Center, Double-Blinded, Placebo Controlled Safety and Early Efficacy Trial of Cryopreserved Cord Blood Derived T-Regulatory Cell Infusions (CK0802) in the Treatment of COVID-19 Induced ARDS. (RESOLVE Trial)

Background. COVID19 associated moderate to severe acute respiratory distress syndrome (ARDS) is associated with high rates of morbidity and mortality. Immune dysfunction and hyper-inflammatory responses result in a vicious cycle of tissue inflammation and end organ damage. Based on the suggestion of early efficacy of adoptive therapy with allogeneic T regulatory cells in COVID19 ARDS (Gladstone et al., Ann Int Med 2020), Cellenkos ® initiated a randomized, placebo controlled, multi-center trial of multiple doses of CK0802 (allogeneic, off-the-shelf, cryopreserved, cord blood derived T regulatory cells) for treatment of moderate-to-severe COVID19-related ARDS patients. Study design. Multi-center, randomized, blinded, placebo controlled trial of CK0802 at two different doses (100 million cells and 300 million cells ) were compared to placebo. Each patient was randomized to receive the assigned product on days 0, 3 and 7 (Figure 1), without HLA matching. Enrollment was staggered for the first 6 active treatment patients with 7 days between each patient while monitoring for any safety signals. Subsequent patients were enrolled on a continuous basis. DSMB monitoring occurred after every cohort of 15 patients (5 controls;5 of each active treatment). Results are presented as median (with range) unless otherwise indicated. Primary Outcomes. The two co-primary outcomes were: • Dose Limiting Toxicity (DLT) = Regimen related grade 3, 4, or 5 toxicity within 48 hours of first infusion • S28 = [Alive and not intubated 28 days after the date of first infusion] = 28-day treatment success Secondary Outcomes. Secondary outcomes, recorded from first day of infusion up to 28 days later, included: i) time to extubation, ii) ventilator-free days;iii) organ failure-free days;iii) ICU free days;iv) PaO 2/FiO 2 between days 0 and 11;and v) 28-day all-cause mortality Covariates. Patient covariates recorded at enrollment included: i) age, ii) gender iii) on vasopressors;iii) on hemodialysis;iv) duration of intubation prior to enrollment. Study Conduct. The multicenter study (n=5 centers) was activated in October 2020 and enrollment completed in March 2021. Results. Forty-five patients were enrolled (60% male, median age 60 [range 21-85], 46.7% Caucasian race). At baseline 13% were on hemodialysis;62% on vasopressors;SOFA score=8 (6-13);PaO 2=85 mmHg (45-133);FiO 2=60% (40-100);PEEP=10 cmH 2O (5-18) with a median duration of intubation of 48 hrs (0-120) prior to enrollment. Patient were intubated a median of 72 [0-144] hours prior to infusion. Sixty percent of patients were alive and extubated at day 28. Median time to extubation from first infusion was 10.5 [2-46] days and median ventilator free days at day 28 was 12 [0-26]days. No treatment related SAEs were reported. Time to extubation from first infusion was 10.5 days (2-46) and at day 28 the ventilator free days were 12 (0-26). The estimated day 28 overall survival was 78.6% with the following breakdown according to the co-variates: i) age>60 yrs =77.5% vs. age<60yrs=79.9%;ii) female=85.7% vs male=73.7%;iii) on vasopressor=65.8% vs. 77.8%;iv) on hemodialysis=75% vs. 79%. Duration of intubation to enrollment had no impact on 28d survival. At baseline, 14 pts were positive for both HLA I and HLA II antibodies (Abs);3 pts positive for HLA I Ab only, and 9 positive for HLA II Ab only. In 20 paired samples collected on day 0 and day 28, HLA I Ab and HLA II Ab seroconversion was observed in 4 and 1 pt, respectively. Discussion This is the first clinical trial to examine safety and early efficacy of multiple doses of allogenic, off-the-shelf, cryopreserved, T regulatory cells for the treatment of COVID-19-related ARDS. Full data analysis of treatment groups (placebo;CK0802-100 million;CK0802-300 million) is ongoing and will be presented at the conference. Additional data to be presented will include: 3- and 6- month QOL, mental health, and cognitive index analyses, and paired Biomarker analysis. [Formula presented] Disclosures: Hari: Janssen: Honoraria, Membership on an ntity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau;GSK: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau;Celgene-BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau;Millenium: Membership on an entity's Board of Directors or advisory committees, Research Funding;Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau;Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau;Adaptive Biotech: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding, Speakers Bureau;Karyopharm: Consultancy;Oncopeptides: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Sadeghi: Cellenkos Inc.: Current Employment. Parmar: Cellenkos Inc.: Current holder of individual stocks in a privately-held company, Membership on an entity's Board of Directors or advisory committees, Patents & Royalties, Research Funding. Mukherjee: Vor Biopharma: Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees, Patents & Royalties: coinventor on issued and pending patent applications licensed to Vor Biopharma. S.M. has equity ownership and is on the Scientific Advisory Board of Vor Biopharma., Research Funding.

Pre-service Teachers’ Readiness and Engagement for Online Learning During the Covid-19 Pandemic: A Rasch Analysis

The widespread of the COVID-19 pandemic has challenged training institutions to rethink the execution of their training programs. New approaches to teaching and learning are now needed due to the forced shift to e-learning modes. However, questions remain about how ready pre-service teachers are and their level of engagement in an online learning model of instruction. The purpose of this study was to investigate the readiness and engagement of pre-service teachers for online learning in Indonesia. This study used a non-experimental quantitative research design. Data were gathered from a sample of 285 pre-service teachers using a questionnaire. Data were analysed using WINSTEPS Rasch model measurement software version 4.30. Descriptive statistical analysis was used to examine pre-service teachers’ readiness and engagement of pre-service teachers for an online learning model of instruction, and a Differential Item Functioning (DIF) analysis was carried out to specifically assess their readiness and engagement for online learning based on their gender and age. Findings indicate pre-service teachers were not ready for online learning during the Covid-19 Pandemic in Indonesia. However, pre-service teachers were found to be actively engaged in online learning. Further analysis indicated there were differences in pre-service teachers’ readiness and engagement in online learning based on their gender and age. This study provides insight into pre-service teachers towards an online learning model of instruction in Indonesia, discusses implications, and offers recommendations for future research. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Identification of a microbiome signature predicting immune checkpoint inhibitor outcomes across multiple cancer types in the MITRE study

Background: The gut microbiome is implicated as a biomarker of response to immune checkpoint inhibitors (ICIs), based on preclinical mouse models and preliminary observations in limited patient series. Furthermore, early reports suggest faecal microbial transfer may have therapeutic potential, converting ICI nonresponders to responders. So far, identification of specific responsible bacterial taxa has been inconsistent between published studies, which limits future application. By culturing and metagenomic sequencing of stool sample bacteria, our group has identified a unique microbiome signature, which appears to be predictive of response to ICIs across all key published series as well as our own melanoma patient series (Robinson M et al, J Immunother Cancer 2020;8(suppl 3):A404). Because the patient numbers in all published series remain low, we are now further exploring and validating this microbiome signature in a larger scale study across several different cancer types. Methods: MITRE (Microbiome Immunotherapy Toxicity and Response Evaluation) is a UK NIHR portfolio multi-centre prospective study funded jointly by Cancer Research UK and Microbiotica (NCT04107168) Up to 1800 patients receiving ICIs will be recruited over a 5-year period. In the first stage 1: anti-PD1 monotherapy, cohort 2: antiPD1+anti-CTLA-4 combination), renal cancer (cohort 3: anti-PD(L)1+kinase inhibitor, cohort 4: anti-PD1+anti-CTLA-4 combination) and nonsmall cell lung cancer (cohort 5: anti-PD(L)1 monotherapy, cohort 6: antiPD(L)1+chemotherapy+anti-angiogenic) are being recruited, 50 patients to each cohort. A cohort-specific, simulation-based power calculation will then be performed, guiding subsequent recruitment. Stool and blood are collected prior to treatment, at 3, 6 and 12 months, or disease progression (whichever is sooner), as well as after any grade >3 immunerelated adverse events. Patients collect and freeze their own stool samples which are cultured and subjected to shotgun metagenomic sequencing. Plasma, whole blood buffy coat, RNA and PBMCs are being stored for correlative studies. Any tumour, or organ biopsies, taken prior to and during treatment are also being collected. Clinical data collection includes treatment, disease response (using RECIST criteria) and toxicity. The primary outcome measure is 1 year progression-free survival. Patients are also asked to invite a household member to be part of the study control group. Recruitment started in July 2020 The Covid-19 pandemic hindered recruitment last year, but the protocol was amended to incorporate a Covid-19 substudy (to document testing, infection and vaccination) and adapt processes for remote trial delivery as much as possible. As of February 2021, 7 sites have opened, 17 patients and 5 household controls have been recruited.

Telemedicine in a tertiary rhinology and endoscopic skull base surgery practice: Utility, impact, and patient satisfaction in the post-COVID-19 era

Introduction: Telemedicine may be a strategy to provide timely care to patients in the rhinology and endoscopic skull basesurgery (ESBS) practice due to the coronavirus disease-19 (COVID-19) pandemic. Few studies have investigated its utilityin otolaryngology, and none have assessed its application to the ESBS practice. This study aims to assess the utility oftelemedicine to increase patient access and determine patient satisfaction in this setting. Methods: This project was considered as a quality improvement initiative and was therefore exempt from institutionalreview board review. A retrospective chart review between July 1 and August 31, 2020, extracted demographic and clinicalinformation from new patient telemedicine and in-person visits in our ESBS practice (rhinology and neurosurgery). Aseparate phone survey was conducted in a subset of patients after their visits answering questions related to satisfactionscored on a 5-point Likert scale ([ Fig. 1 ]). Univariate analysis with Mann-Whitney and Fisher's exact tests were performed for continuous and categorical variables. Results: Overall, there were 137 patients who were seen in-person or via telemedicine. Mean age was 52.7 ± 16.2 years, 59(43.1%) were white, and 85 (62.0%) were female. The majority, 115, (84.0%) were seen by an otolaryngologist and 22(16.1%) by a neurosurgeon. One-hundred thirteen (82.5%), 18 (13.1%), and 6 (4.4%) patients underwent in-office, video,and telephone visits, respectively. The median distance from patient residence to the clinic was 12.3 miles (range: 0.6-184.0). The median round-trip drive time was 52 minutes (range: 6.0-420.0;[ Fig. 2 ]). Median expected round-trip drivetime did not significantly differ between telemedicine and in-person visits (58 and 52 minutes, respectively). For those whoreceived phone surveys ( N = 30), the mean age was 50.0 ± 14.7 years, 15 (50.0%) were African American, and 17 (56.7%)were female. Twenty-five (83.3%) and 5 (16.7%) patients had an otolaryngology and neurosurgery appointment,respectively. Seventeen (56.7%), 11 (36.7%), and 2 (6.7%) patients had an in-office, video, and telephone visit,respectively. Half were new and half were return visits. The majority (27/30, 90%) reported overall satisfaction with theirvisit as defined by a score of 4 or 5 on the Likert scale, and 20/30 (66.7%) believed telemedicine to be more convenientthan in person. Nevertheless, the majority (20/30, 66.7%) expressed a preference for a future visit to occur in person.Patient satisfaction was not associated with age, race, mode of visit (telemedicine vs. in person), visit specialty, or visitstatus (new vs. return;p > 0.05, all). Conclusion: Patients with rhinology and skull base pathology would gain better access to care with less travel time usingtelemedicine. Although the majority were satisfied with telemedicine and its convenience, most patients still prefer in-person consultation. Telemedicine could prove useful in screening patients in the tertiary ESBS setting in the post-COVID-19 era prior to in person evaluation.

Students' readiness for e-learning during the COVID-19 pandemic in a South-East Asian university: a Rasch analysis

Purpose: Universities have shifted from face-to-face learning environments to e-learning in response to the COVID-19 pandemic. However, the sudden change to online teaching has raised concerns among lecturers about students' readiness for e-learning. This study investigates students' readiness for e-learning during the COVID-19 pandemic and specifically assesses any significant differences between students' gender, age, ethnicity, level of education, field of study and their readiness for an e-learning environment. Design/methodology/approach: The study employed a non-experimental quantitative research design. Data were gathered from a sample of 298 undergraduate and 101 postgraduate students. WINSTEPS Rasch model measurement software was used to determine the reliability and validity of the research instrument. Descriptive, inferential statistics and differential item functioning (DIF) test were used to assess students' readiness for an e-learning mode of instruction with the latter specifically analysing students' demographic factors and their readiness for an e-learning environment. Findings: Findings identified that most students are ready for an e-learning mode of instruction. Further analysis indicated that there were differences in students' readiness for e-learning based on their demographic profiles. Research limitations/implications: This study provides insights on students' readiness towards e-learning, discusses implications for e-learning practices in higher education institutions during the COVID-19 pandemic and offers recommendations for future research. Originality/value: This study provides evidences of students' readiness for e-learning in respect to their gender, age, ethnicity, level of education and field of study. This information could help lecturers to reflect on their own teaching practices, adjust their teaching approaches and subsequently, develop appropriate e-learning methods that best suit the student diversity in their classrooms. © 2021, Emerald Publishing Limited.

Guidance for the care of neuromuscular patients during the COVID-19 pandemic outbreak from the French Rare Health Care for Neuromuscular Diseases Network.

In France, the epidemic phase of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in February 2020 and resulted in the implementation of emergency measures and a degradation in the organization of neuromuscular reference centers. In this special context, the French Rare Health Care for Neuromuscular Diseases Network (FILNEMUS) has established guidance in an attempt to homogenize the management of neuromuscular (NM) patients within the French territory. Hospitalization should be reserved for emergencies, the conduct of treatments that cannot be postponed, check-ups for which the diagnostic delay may result in a loss of survival chance, and cardiorespiratory assessments for which the delay could be detrimental to the patient. A national strategy was adopted during a period of 1 to 2months concerning treatments usually administered in hospitalization. NM patients treated with steroid/immunosuppressants for a dysimmune pathology should continue all of their treatments in the absence of any manifestations suggestive of COVID-19. A frequently asked questions (FAQ) sheet has been compiled and updated on the FILNEMUS website. Various support systems for self-rehabilitation and guided exercises have been also provided on the website. In the context of NM diseases, particular attention must be paid to two experimental COVID-19 treatments, hydroxycholoroquine and azithromycin: risk of exacerbation of myasthenia gravis and QT prolongation in patients with pre-existing cardiac involvement. The unfavorable emergency context related to COVID-19 may specially affect the potential for intensive care admission (ICU) for people with NMD. In order to preserve the fairest medical decision, a multidisciplinary working group has listed the neuromuscular diseases with a good prognosis, usually eligible for resuscitation admission in ICU and, for other NM conditions, the positive criteria suggesting a good prognosis. Adaptation of the use of noninvasive ventilation (NIV) make it possible to limit nebulization and continue using NIV in ventilator-dependent patients.

COVID-19 cases are less prevalent in countries where malaria is endemic, suggesting a role for anti-malarial drugs as prophylaxis

Almost every country across the world has felt the repercussions of the pandemic of disease termed coronavirus disease 2019 (COVID-19) caused by the novel coronavirus identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A recently published article points to a method of prevention and prophylaxis of COVID-19 through the use of anti-malarial drugs such as the 4-aminoquinolones: chloroquine and hydroxychloroquine, based on their mechanisms of action against SARS-CoV-2. This report aims to explore the correlation between COVID-19 cases and countries where malaria is prevalent using statistical means. It is hypothesized that countries where malaria is endemic will have few cases of COVID-19 since these countries use the 4-aminoquinolone antimalarial drugs for prophylaxis. Statistical analysis demonstrates that the numbers and incidence of COVID-19 cases and COVID-19 related deaths are substantially lower (multiple-fold lower) in countries with the highest prevalence of malaria. The difference between both the COVID-19 incidence rate and the COVID-19 mortality rate in malaria prevalent countries compared to COVID-19 prevalent countries is statistically significant (p = 0.02 and p = 0.04 respectively). This study provides further evidence that anti-malaria drugs may prove essential to breaking the spread of SARS-CoV-2 and preventing COVID-19 and COVID-19 related mortality. As the pandemic continues to evolve and doctors and researchers across the globe try to attenuate or stop the spread of SARS-CoV-2, the medical community should not overlook the potential role of the 4-aminoquinolones anti-malarial drugs, chloroquine and hydroxychloroquine, and 8-aminoquinolone anti-malaria drugs, tafenoquine and primaquine, as a prophylaxis.