ABSTRACT
Background/Aims The impact of the pandemic on the incidence and management of inflammatory arthritis (IA) is not understood. Routinely-captured data in secure platforms, such as OpenSAFELY, offer unique opportunities to understand how IA was impacted upon by the pandemic. Our objective was to use OpenSAFELY to assess the effects of the pandemic on diagnostic incidence and care delivery for IA in England, and replicate key metrics from the National Early Inflammatory Arthritis Audit. Methods With the approval of NHS England, we used primary care and hospital data for 17 million adults registered with general practices using TPP health record software, to explore the following outcomes between 1 April 2019 and 31 March 2022: 1) incidence of IA diagnoses (rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, undifferentiated IA) recorded in primary care;2) time to first rheumatology assessment;3) time to first prescription of a conventional synthetic DMARD (csDMARD) in primary care, and choice of first csDMARD. Results From 17,683,500 adults (representing 40% of the English population), there were 31,280 incident IA diagnoses recorded between April 2019 and March 2022. New IA diagnoses decreased by 39.7% in the early months of the pandemic. Overall, a 20.3% decrease in IA diagnoses was seen in the year commencing April 2020, relative to the preceding year (5.1 vs. 6.4 diagnoses per 10,000 adults, respectively). Further decreases coincided with rising COVID-19 numbers, before returning to pre-pandemic levels by the end of the study period. No rebound increase in IA incidence was observed as of April 2022. The median time from referral to first rheumatology assessment was shorter during the pandemic (18 days;IQR 8-35 days) than before (21 days;9-41 days). The proportion of patients prescribed csDMARDs in primary care was comparable to before the pandemic;however, fewer people were prescribed methotrexate or leflunomide, and more were prescribed sulfasalazine or hydroxychloroquine. Conclusion IA diagnoses decreased markedly during the early phase of the pandemic;however, the impact on rheumatology assessment times and DMARD prescribing was less marked than might have been anticipated. This study demonstrates the feasibility of using routinelycaptured, near real-time data in the secure OpenSAFELY platform to benchmark care quality on a national scale, without the need for manual data collection.
ABSTRACT
Although there is extensive literature documenting hands-on learning experiences in engineering classrooms, there is a lack of consensus regarding how student learning during these activities compares to learning during online video demonstrations. Further, little work has been done to directly compare student learning for similarly-designed hands-on learning experiences focused on different engineering subjects. As the use of hands-on activities in engineering continues to grow, understanding how to optimize student learning during these activities is critical. To address this, we collected conceptual assessment data from 763 students at 15 four-year institutions. Students completed activities with one of two highly visual low-cost desktop learning modules (LCDLMs), one focused on fluid mechanics and the other on heat transfer principles, using two different implementation formats: either hands-on or video demonstration. Conceptual assessment results showed that assessment scores significantly increased after all LCDLM activities and that gains were statistically similar for hands-on and video demonstrations, suggesting both implementation formats support an impactful student learning experience. However, a significant difference was observed in effectiveness based on the type of LCDLM used. Score increases of 31.2% and 24% were recorded on our post-activity assessment for hands-on and virtual implementations of the fluid mechanics LCDLM compared to pre-activity assessment scores, respectively, while significantly smaller 8.2% and 9.2% increases were observed for hands-on and virtual implementations of the heat transfer LCDLM. In this paper, we consider existing literature to ascertain the reasons for similar effectiveness of hands-on and video demonstrations and for the differing effectiveness of the fluid mechanics and heat transfer LCDLMs. We discuss the practical implications of our findings with respect to designing hands-on or video demonstration activities.
ABSTRACT
Our team has developed Low-Cost Desktop Learning Modules (LCDLMS) as tools to study transport phenomena aimed at providing hands-on learning experiences. With an implementation design embedded in the community of inquiry framework, we disseminate units to professors across the country and train them on how to facilitate teacher presence in the classroom with the LC-DLMs. Professors are briefed on how create a homogenous learning environment for students based on best-practices using the LC-DLMs. By collecting student cognitive gain data using pre/posttests before and after students encounter the LC-DLMs, we aim to isolate the variable of the professor on the implementation with LC-DLMs. Because of the onset of COVID-19, we have modalities for both hands-on and virtual implementation data. An ANOVA whereby modality was grouped and professor effect was the independent variable had significance on the score difference in pre/posttest scores (p<0.0001) and on posttest score only (p=0.0004). When we divide out modality between hands-on and virtual, an ANOVA with an F-test using modality as the independent variable and professor effect as the nesting variable also show significance on the score difference between pre and posttests (p-value=0.0236 for hands-on, and p-value=0.0004 for virtual) and on the posttest score only (p-value=0.0314 for hands-on, and p-value<0.0001 for virtual). These results indicate that in all modalities professor had an effect on student cognitive gains with respect to differences in pre/posttest score and posttest score only. Future will focus on qualitative analysis of features of classrooms yield high cognitive gains in undergraduate engineering students. © American Society for Engineering Education, 2022.
ABSTRACT
Many recommended stability practices have been unchanged for decades and yet the retail landscape has considerably evolved during that time. First, as a result of the rise of social media and second in the wake of the COVID-19 global pandemic. This article reviews the published guidelines available to the cosmetic scientist when developing a suitable stability protocol and considers them in the context of a changing retail landscape. It sets the context with a background to stability testing and a summary of the relevant regulations across different territories. It outlines the current recommended guidelines for stability testing as stated in publications, including the International Federation of the Societies of Cosmetic Chemists (IFSCC) monograph and Cosmetics Europe. Modern advances in stability testing are also considered including early stability prediction techniques. The article concludes that accelerated stability testing is not a precise science, rather a prediction of shelf life. Scientists must consider the various modes of transport, sizes of shipments and regulation in the country of destination as well as the new and emerging ways of consumer production interaction when developing a suitable stability protocol for their formulation. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
ABSTRACT
AIMS: To report long-term outcomes of patients treated with stereotactic ablative radiotherapy (SABR) for early stage, peripherally located non-small cell lung cancer. MATERIALS AND METHODS: Data were collected retrospectively between September 2009 and May 2019. Electronic medical records were reviewed for baseline characteristics, treatment details and outcomes. All patients were treated according to local protocol based on the national UK SABR Consortium guidelines. Risk-adapted treatment schedules were used depending on the size and the location of the tumour (54 Gy in three fractions, 55 Gy in five fractions, 60 Gy in eight fractions or 50 Gy in 10 fractions). Overall survival outcomes were evaluated using the Kaplan-Meier method. RESULTS: In total, 412 patients were included in the analysis. The median age was 76 years (range 48-93 years). Histological confirmation was obtained in 233 cases (56.6%). The median overall survival for all patients was 42.3 months (95% confidence interval 37.3-47.3 months), with 3- and 5-year overall survival of 52.8% and 37.3%, respectively. For biopsy-proven patients (56.6%), 3- and 5-year overall survival was 57.3% and 40.1%, respectively. With respect to overall survival, univariate and multivariate analysis revealed no significant difference in survival by technique (volume-modulated arc therapy versus conformal; three-dimensional computed tomography versus four-dimensional computed tomography), tumour location, smoking status at first contact, pre-treatment tumour stage or pre-treatment standardised uptake value. Survival was poorer for patients who received the 50 Gy in 10 fractions schedule. Treatment was very well tolerated with very low rates of grade 3-4 toxicity (1%). CONCLUSIONS: SABR for peripherally located, medically inoperable non-small cell lung cancer can be safely and effectively implemented in a non-academic institution with appropriate equipment and training. Overall survival outcomes and toxicity rates are comparable with internationally published studies. Patients treated with 50 Gy in 10 fractions had a poorer survival outcome.