THE OPEN CAGE: A FORCE FOR TRANSFORMATIVE LEARNING IN PROFESSIONAL DOCTORAL STUDIES DURING COVID-19

Aim/Purpose This paper explores how professional doctorate candidates responded to the restrictions and changed context of COVID-19. Using connectivism as a theoretical framework, it explores the ways in which their patterns of study were recalibrated in light of the restrictions caused by the pandemic. Specifically, this study aims to: explore the experience of the professional doctorate student during the pandemic;and demonstrate the ways in which networks are recalibrated and adapt to changing circumstances. Background In 2020, in response to COVID-19 many countries, including the UK, went into lockdown resulting in most doctoral candidates being confined to their homes and restricted to online contact with peers and supervisors. Part-time students have a finely balanced pattern of work which was required to be recalibrated and refocused which required considerable adaptation on the part of the candidates. Methodology A qualitative methodology was used comprising four focus groups, each consisting of four professional doctorate candidates. Participants were professional doctorate candidates and as such were all mid-career professionals from a variety of backgrounds. Purposeful sampling was combined with theoretical sampling, which ensures the sample is deliberately selected and ensures the emergent development of the theoretical ideas. The focus groups were recorded and transcribed. Thematic analysis was used to analyse the data and identify the main findings, allowing themes to be identified. Contribution The findings indicated that professional doctorate candidates were highly adaptable and were able to adjust rapidly in response to COVID-19 restrictions. The networks they had previously established had to be refocused through adapting and adjusting patterns of study and developing digital skills to enable them to progress in their doctoral studies. Findings Three themes emerged from the analysis: recalibrating work-life-study balance;adaptivity in studies and research;and empowerment through Information and Communications Technology (ICT). To progress their doctoral studies, the networks they had previously established had to be refocused through adapting and adjusting patterns of study. Recommendations While lockdown was an unusual experience, some factors can inform future defor Practitioners velopments for doctoral education, mainly: the importance of establishing a pattern of study;the importance of connectivism and Information Technology (IT);and how such use can enhance and expand the research process. Recommendations Adaptivity achieved through IT;connectivity and the recalibration of networks for Researchers were key to enabling doctoral candidates to continue their research. The use of connectivism as a theoretical framework for research merits further exploration, as do methods for online learning and approaches to incorporating digital skills into doctoral studies. Impact on Society According to connectivism, learning is through the establishment of networks, and these consist of both the means of gaining and accessing knowledge and the work-life study balance. It is important to examine and improve these networks. Many of the changes imposed by the COVID-19 restrictions are here to stay and this study highlights the ways in which the student experience can be enhanced through digital learning. Future Research This research could be expanded through further analysis of how IT can enhance research practice. The interaction with digital learning sources could be explored and highlighted. The pattern of networks could also be explored and developed, and the positive and negative aspects could be highlighted. © 2022 Informing Science Institute. All rights reserved.

EVALUATION OF A TRANSITIONS CLINIC TO BRIDGE EMERGENCY DEPARTMENT AND PRIMARY CARE

BACKGROUND: Suboptimal transitions from emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary non-urgent ED utilization. Primary care-staffed care transition clinics (CTCs) are a potential solution to reduce ED crowding by providing ED follow-up care and facilitating the bridge to longer-term primary care. This study is a preliminary evaluation of the initiation of an ED transitions clinic on 30-day ED and hospital readmissions. METHODS: This retrospective cross-sectional study included adults discharged from the ED at UC hicago Medicine referred to the transitions clinic between November 2020 and May 2021. Appointment attendance, frequency of care type provided, and percent contacted with patient advocate were computed to assess clinic utilization. 30-day ED and hospital readmissions were compared between patients who completed their CTC appointment and patients who missed their CTC appointment using a chi-square test. RESULTS: In the first 6 months of program initiation, 116 patients were referred to the CTC from the ED and around half (47%) completed their follow-up appointment. The majority of patients were of black race (90%) and on public insurance (81%). Almost a quarter of referred patients (22%) were contacted by a patient advocate for referral to longer-term care. The most common reasons for referral were wound check (top 3: cellulitis, abscess, suture removal) and clinical problem management (top 3: SOB, chest pain, covid). Wound checks were 20% more likely to be completed compared to clinical appointments (58% show rate vs 38%). Patients who completed their CTC appointment had a lower rate of ED revisits (15% vs 20%) but the effect was not statistically significant (p>0.05). No statistically significant effects were seen for CTC appointment completion on hospital readmission. CONCLUSIONS: Transition clinics may have the potential to help reduce excess ED use for ambulatory care needs, particularly if they can help facilitate patients being connected to more permanent ambulatory care sites and clinicians. In addition to ongoing analysis of this program evaluation regarding ED and hospital utilization, additional research is needed to investigate the factors influencing follow-up completion and identifying effective interventions for increasing appointment attendance.

The Design and Rationale of a Phase 2b, Randomized, Double-Blinded, and Placebo-Controlled Trial to Evaluate the Safety and Efficacy of Lomecel-B in Older Adults with Frailty.

BACKGROUND: Frailty in older adults is a rapidly growing unmet medical need. It is an aging-related syndrome characterized by physical decline leading to higher risk of adverse health outcomes. OBJECTIVES: To evaluate the efficacy of Lomecel-B, an allogeneic medicinal signaling cell (MSC) formulation, in older adults with frailty. DESIGN: This multicenter, randomized, parallel-arm, double-blinded, and placebo-controlled phase 2b trial is designed to evaluate dose-range effects of Lomecel-B for frailty on physical functioning, patient-reported outcomes (PROs), frailty status, and biomarkers. SETTING: Eight enrolling clinical research centers, including the Miami Veterans Affairs Medical Center. PARTICIPANTS: Target enrollment is 150 subjects aged 70-85 years of any race, ethnicity, or gender. Enrollment criteria include a Clinical Frailty Score of 5 ("mild") or 6 ("moderate"), a 6MWT of 200-400 m, and serum tumor necrosis factor-alpha (TNF-α) ≥2.5 pg/mL. INTERVENTION: A single intravenous infusion of Lomecel-B (25, 50, 100, or 200 million cells) or placebo (N=30/arm). Patients are followed for 365 days for safety, and the efficacy assessments performed at 90, 180, and 270 days. MEASUREMENTS: The primary endpoint is change in 6MWT in the Lomecel-B-treated arms versus placebo at 180 days post-infusion. Secondary and exploratory endpoints include change in: 6MWT and other physical function measures at all time points; PROs; frailty status; cognitive status; and an inflammatory biomarkers panel. A pre-specified sub-study examines vascular/endothelial biomarkers. Safety is evaluated throughout the trial. RESULTS: The trial is conducted under a Food and Drug Administration Investigational New Drug (IND), with Institutional Review Board approval, and monitoring by an NIH-appointed independent Data Safety Monitoring Board. CONCLUSION: This clinical trial investigates the use of a regenerative medicine strategy for frailty in older adults. The results will further the understanding of the potential for Lomecel-B in the geriatric condition of frailty.

When Will Immersive Virtual Reality Have Its Day? Challenges to IVR Adoption in the Home as Exposed in Studies with Teenagers, Parents, and Experts

In response to the pandemic, many countries have had multiple lockdowns punctuated by par tial freedoms limiting physically being together. In 2020–2021, during the COVID-19 pandemic, parents were stressed and exhausted by the challenges of work, home schooling, and barriers to typical childcare arrangements. Children were missing one another, their social lives, and the variety of experiences that the world beyond the home brings. Immersive Vir tual Reality (IVR) offers tried and tested ways to enable children to maintain beyond-household family activities and dynamics. However, it is not viewed as a solution. Instead, as demonstrated through a multiple method study involving a Rapid Evidence Assessment, workshops with 91 teenagers, interviews with 15 exper ts, a Delphi study with 21 exper ts, 402 parent questionnaires pre-pandemic, 232 parent questionnaires during the pandemic, and longitudinal interviews with 13 parents during the first UK lockdown in 2020, IVR is not viewed as having value in the home beyond gaming. Results highlight limited consideration of IVR as a way to enhance family life or the home, with a lack of evidence and direction from current research, innovation, and policy. The ar ticle empirically demonstrates that exper ts, teenagers, and parents have limited expectations for VR. Fur ther, with parental resistance to adoption and a lack of ideas or innovations in how IVR could be used, the likelihood of VR-headset adoption remains low as does its potential as a means of educating, enter taining, and socially engaging children and teenagers. © 2021 by the Massachusetts Institute of Technology.

Cutting edge selection: learning from high reliability organisations for virtual recruitment in surgery during the COVID-19 pandemic.

INTRODUCTION: National selection for higher surgical training (ST3+) recruitment in the UK is competitive. The process must prioritise patient safety while being credible, impartial and fair. During the COVID-19 pandemic, all face-to-face interviews were cancelled. Selection was based on a controversial isolated self-assessment score with no evidence checking taking place. From 2021, selection will take place entirely online. Although this has cost and time advantages, new challenges emerge. METHODS: We review surgical selection as it transitions to an online format and suggest validated methods that could be adapted from High Reliability Organisations (HRO). FINDINGS: Virtual selection methods include video interviewing, online examinations and aptitude testing. These tools have been used in business for many years, but their predictive value in surgery is largely unknown. In healthcare, the established online Multi-Specialty Recruitment Assessment (MSRA) examines generic professional capabilities. Its scope, however, is too limited to be used in isolation. Candidates and interviewers alike may have concerns about the technical aspects of virtual recruitment. The significance of human factors must not be overlooked in the online environment. Surgery can learn from HROs, such as aviation. Pilot and air traffic control selection is integral to ensuring safety. These organisations have already established digital selection methods for psychological aptitude, professional capabilities and manual dexterity. CONCLUSION: National selection for higher surgical training (ST3+) can learn from HROs, using validated methods to prioritise patient safety while being acceptable to candidates, trainers and health service recruiters.