A Qualitative Investigation of the Impact of the Sars-Cov-2 Pandemic on Goal Attainment Scaling in a Clinical Research Setting

Objectives: Goal Attainment Scaling (GAS) quantifies the effect of interventions on individuals' personal goals. Goals that are meaningful to individual patients are set by GAS interviewers (physicians/academics, experienced in clinical research/trials) in collaboration with patients and/or their caregivers. The SARS-CoV-2 pandemic presented a major challenge to health care worldwide. We investigated how the SARS-CoV-2 pandemic affected the use and implementation of GAS in clinical/research settings. Method(s): Eleven GAS interviewers in Canada, the US, UK and Australia with current/past experience working with patient-caregivers to identify goals and build scales to measure goal attainment as an outcome were interviewed using a semi-structured approach. They described how the pandemic affected GAS use in clinical/research settings. Interviews were recorded and transcribed, then themes were identified and coded in Nvivo 12. Result(s): Most GAS interviews were moved to the virtual environment during the pandemic (9/11). GAS interviewers identified few negative impacts. Some goals required modification (e.g. going to the gym or shops). Pandemic stress impacted both interviewers and interviewees. Even so, most GAS interviewers (8/11) emphasized positive impacts of the pandemic. These were: 1) the virtual environment meant patients were more readily available as they did not need to travel;2) because interviewers did not have to travel, patient recruitment could be expanded into more remote geographical areas;3) researchers could recruit and retain more participants and collect data more quickly;and 4) interviewers commented they became more open to technology because of the pandemic (9/11). Conclusion(s): Despite the challenges of the SARS-CoV-2 pandemic for health care, most GAS interviewers found that the impacts were largely positive for using GAS in clinical/research settings. The ability to deploy GAS through a virtual platform could facilitate the uptake of GAS as a patient-centric outcome measure.Copyright © 2023

Altmetric Scores in Conservation Science have Gender and Regional Biases

There is a growing view in conservation science that traditional ways to evaluate publications, researchers, and projects are too slow. This has led to a rise in the use of altmetrics, which are metrics based on social media data, news pieces, blogs, and more. Here we examine altmetric data linked to nearly 10,000 papers published in 23 conservation journals, exploring five issues that represent some of the challenges associated with using social media data in evaluating conservation. We discuss whether social media activity reflects meaningful engagement, and how easily individuals can manipulate scores by using bots or simply through active personal networks or institutional promotion services. Our analysis shows a highly skewed distribution of altmetric scores where most papers have such low scores that the scores likely convey little meaningful information. Examining scores that would be considered meritorious, we find that papers where the first author was male have higher scores than papers led by a woman, suggesting a gender bias in altmetric scores. Finally, this data set reveals regional differences that correspond with access to different social media platforms. Metrics, like altmetrics, may have a role to play when making rapid evaluations. However, such metrics should only be used after careful deliberation and should not be influenced by institutions looking for shortcuts, by companies looking to advance profits, or by individuals seeking to promote themselves, rather than generating meaningful engagement in scholarship and conservation action. Scholarly and conservation activities should be judged on the quality of their contributions, which will require the input of experts and direct contact with impacted communities.

A systematic review of GAS implementation practices by caregivers in randomized controlled trials

Aims: Goal attainment scaling (GAS) is an established individualized, patient-centered outcome measure widely used to capture the patient's voice. Although it was first introduced ~ 60 years ago, there are few published guidelines for implementing GAS. This is especially true for its use with caregivers. We conducted a systematic review of randomized controlled trials where GAS was implemented with caregiver input. Method(s): The search protocol was registered in PROSPERO (Oct 2021). We searched Medline, Embase, Cochrane, PsycInfo and CINAHL databases. Variations of these keywords were searched: randomized controlled trials, family caregiver and proxy, goal setting/planning/ attainment/achievement. Three researchers screened and reviewed articles, with one reviewer screening all s and full texts, and the second reviewer screening 25% of s. Covidence software was used to perform screening and data extraction. Result(s): Of 2205 studies imported for screening, 20 studies were included for the final data extraction. Most studies (55%) had GAS as a primary outcome, with over 75% of studies having children as study participants. The most common disorders represented in the review were cerebral palsy (40%), developmental delay disorders (25%) and dementia/Alzheimer's disease (20%). Essential details including the number of goals set, number of attainment levels, baseline level, and training given to GAS facilitators were missing from most studies. Disease-specific semi-standardized goal inventories were not provided. The traditional five-point GAS scale from -2 to + 2 was most commonly implemented, with -1 level being the baseline. Both caregivers and patients were involved in the goalsetting process, with clinicians assessing goal attainment post-intervention. T-tests were often used to analyze most between-group treatment effects, and mean change score was the most common effect size measure reported (median of the mean change score = 5.4, ranging from 0.8 to 45.2). Conclusion(s): GAS with caregivers was feasible in randomized controlled trials across a range of disorders, in diverse patient populations and across disciplines. Many crucial details related to the specifics of GAS implementation were not reported, this limits the potential for reproducibility. A standardized checklist for consistent reporting of GAS details seems useful. In addition, the inclusion of semi-standardized goal inventories may enhance the application of this patient-centered outcome measure.

Foundry compatible fabrication of Si3N4 microring resonators for 15-plex biosensing at 1310nm

The advent of the SARS-CoV-2 pandemic has rekindled the demand for inexpensive, point-of-care and at-home diagnostic systems that offer high degrees of scalability, sensitivity, and specificity. While several options of sensing modalities have been researched and subsequently commercialized, these sensing systems are yet to simultaneously satisfy the spiked demand for higher accuracy and scalable manufacturing. In this context, the prospect of integrated photonics-enabled biosensors has garnered immense attention from both scientific and business communities. However, realizing low group indices of the photonic structures required for higher bulk sensitivities at commonly used telecom operation wavelengths is typically achieved using design approaches incompatible with foundry process constraints. Siphox Inc., founded in 2020, developed an ensemble biosensing platform by merging the benefits of CMOS-friendly integrated photonic structures with proprietary biochemical assays to realize low-cost, highly sensitive, label and label-free, multiplexed diagnostic system. As a first demonstration, we present our results of 15-plex biosensing utilizing low-loss (<3.5dB/cm) Si3N4 strip-waveguide ring resonators fabricated using 248 nm deep UV (DUV) stepper lithography. We describe the design, simulation, and measurement results of bulk and surface sensitivities and detection limits for our TE-polarized waveguide resonator structures operating at O-band (1310 nm). We demonstrate a bulk sensitivity of >117 nm/RIU and an intrinsic limit of detection of 1.87x10(-4) RIU.

GETTING PREP'ED FOR PRIDE: PROVIDING PREP AT A LOCAL PRIDE EVENT DURING COVID-19

Introduction In attempts to further promote awareness and availability of HIV Pre-Exposure Prophylaxis (PrEP) within local LGBTQ+ communities a pop-up clinic was held at the 2021 Bournemouth Pride event. Patients were educated about PrEP, Point-of-Care tested for HIV and Syphilis and given the option of starting an event-based regimen to cover for risk over the Pride weekend. Methods Event-based PrEP was initiated in patients undertaking a self-completion triage form, consultation and pointof- care testing. Patients took the first dose immediately and left the consultation with two follow-up doses of PrEP with text reminders scheduled to promote adherence. All patients were offered a follow-up appointment, given access to STI screening and further information about chemsex harm minimisation. Results 8 patients were given event-based PrEP during the event. All patients were cis-male and identified as men who have sex with men. None of them reported previous PrEP use. All patients made follow-up appointments for continuation PrEP whilst at the event and all patients attended this and continued PrEP. At this follow up visit, all patients disclosed HIV risk at the event. No patients required further 'emergency' dosing after the event. 3 patients self-sourcing PrEP asked to be 'converted' to NHS supply and were booked into follow up clinics at the event. Discussion Owing to the successful local rollout of PrEP since November 2020, many of the event attendees were already accessing PrEP. However, presence at a community LGBTQ+ event helped to further promote awareness of PrEP and encouraged high risk patients to attend mainstream services.

Academic Incentives Should Not Promote the "Extinction of Nature Experience"

Evidence suggests that a decline in people's exposure to nature corresponds to decreasing support for nature-a phenomenon we call extinction of nature experience. Here, we evaluate three current trends in conservation research and consider if they contribute to a decrease in exposure to nature. We suggest that while using sensors, algorithms, technocentric thinking, conducting meta-analyses, and taking more lab-based approaches all have significant potential to advance conservation goals, they lead to researchers spending less time in the field and an extinction of nature experience. A reduction of researcher field time will mean fewer local field assistants are hired and trained;lower engagement of researchers with ground realities;and a rift in conservation research, planning, and implementation. We suggest that the field of conservation science should balance how it allocates time and rewards to field versus non-field components. If we are not careful, we will select researchers that are distant from the biodiversity itself and the communities that are affecting it locally. Since the pandemic began many researchers were unable to go to their field sites and if care is not taken, the pressures that promote the extinction of nature experience may be promoted by institutions in a post-COVID-19 world.

Social disruption of the tourism and hospitality industries: implications for post-COVID-19 pandemic recovery. (Special Issue: Tourism and hospitality post-disaster and crisis: how can global resilience be enhanced?)

Purpose: The purpose of this study is to examine how societal disruptions in the wake of disasters and crises also disrupt the tourism and hospitality industries. Design/methodology/approach: This paper takes a case-study approach. First, the literature on disasters/crises is reviewed;then three cases in which disasters impacted local, regional and global tourism and hospitality industries are examined: Hurricane Katrina, Arab Spring and the COVID-19 pandemic. Findings: Three principles are proposed to assist in mitigating the impacts of disaster on the tourist industry. These principles also serve as a means of potentially re-orienting and guiding the tourism and hospitality industries toward a sustainable and equitable future. Originality/value: In addition to the three guiding principles offered in this paper;the examination of COVID-19 offers a novel case in which tourism is impacted globally by a singular disaster. Findings and implications from this case will guide recovery and, potentially, allow for a reconceptualization of the tourism and hospitality industries.

Cladribine to halt deterioration in people with advanced multiple sclerosis (chariotms)

Background: Whilst the introduction of disease modifying treatments (DMTs) has transformed the management of people with early/relapsing MS (pwRMS), the use of DMTs in people with MS who are largely or completely wheel chair-dependent (EDSS>6.5) remains controversial. Evidence suggests that slowing or stopping disease deterioration is possible even past this arbitrary (loss of ambulatory function) threshold. Pathology and anecdotal clinical data support the hypothesis that even at an advanced stage of MS (AMS) inflammatory activity is a key driver of functional decline and that effective immunotherapy may halt this process. Cladribine tablets are a highly effective and central nervous system (CNS) penetrant DMT for people with highly-active RMS. It effectively depletes B cells, particularly memory B cells, a likely key mechanism of disease control in MS. Evidence, suggesting that (i) a significantly higher number of CNS axons supply upper compared to lower limb functions and (ii) longer axons are more vulnerable to the effects of focal inflammatory demyelination than shorter ones, corroborate our hypothesis that upper limb function can be protected even beyond EDSS=6.5. Objectives: Primary Objective: To investigate whether cladribine tablets over 24 months is an effective DMT in people with AMS (pwAMS;EDSS=6.5-8.5) as measured using the 9-hole peg test (9HPT) peg speed. Secondary Objectives: To establish whether there is a difference in pwAMS between treatment with cladribine tablets or placebo in (i) blood/serum biomarkers of inflammation (lymphocyte subsets) and/or neurodegeneration (neurofilament light chain), (ii) MRI loss of brain volume and spinal cord cross sectional area, (iii) T2 lesion burden, (iv) hypointense lesions on T1 weighted scans, (v) quality of life, and (vi) whether cladribine is a cost-effective treatment for pwAMS. Methods: Randomised, double-blind, placebo-controlled phase IIb trial. To detect a 15% treatment effect in 9HPT peg speed with 90% power at 5% significance and 20% drop-out over 104 weeks n=200 pwAMS will be recruited across 20 UK MS centres. Results: Protocol and ancillary documents have been submitted for ethics approval. So far 17 centres have agreed to recruit pwAMS for ChariotMS. Due to the COVID-19 pandemic start of recruitment has been deferred to 04 Jan 2021. Conclusions: ChariotMS will be the first DMT-trial focussing on pwAMS. If successful, ChariotMS would expand the DMT landscape to include pwAMS and provide a platform for add-on therapies.

Building back better education systems: equity and COVID-19

Purpose: The purpose of this article is to explore the relationship between the COVID-19 pandemic and the potential to use this challenging global context as an opportunity to build back better and more equitable educations systems. Design/methodology/approach: The approach taken involves drawing on the emerging literature to explore the relationship between COVID-19 and educational equity. Findings: The analysis undertaken involves the presentation of a typology framed by the quality of educational offer and the opportunity for engagement in the offer accompanied by four reflective questions for further consideration. Originality/value: The analysis presented here underpins the presentation of a heuristic typology designed to stimulate exploration and discussion relating to building back better, more equitable education systems after the COVID-19 pandemic. © 2020, Emerald Publishing Limited.