Using Q method to investigate the influence of inclusive water, sanitation and hygiene (WASH) on tourists' hotel choice in Fiji

Consequent to the COVID-19 pandemic and the reopening of international borders, tourists are increasingly concerned about sanitation and hygiene practices in tourism destinations. There is an evident need to investigate how the COVID-19 pandemic has transformed tourist choices. This paper investigates the perceptions of hotel staff and tourists on the influence of inclusive water, sanitation, and hygiene (WASH) practices on tourists' hotel choices in Fiji. This study explores the value of Q-methodology through a case study of Fiji with data collected from 80 hotel staff and 75 tourists. The findings demonstrate that Q-methodology is effective in identifying three tourist types who have a strong interest in WASH impacts and aspects of their safety including concerns about how their visit impacts the local community and environment. Similarly, the Q method was useful in identifying four perspectives of staff understanding on WASH impacts that are significant to tourists' choice of hotel. The findings suggest a significant potential for hotel operators to enact socially inclusive WASH practices to enhance their appeal in the ‘new normal'. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Evaluation of Bivalirudin Anticoagulation in Patients on Ecmo Due to Covid-19 Respiratory Failure

INTRODUCTION: Patients supported on extracorporeal membrane oxygenation (ECMO) due to COVID-19 are at an increased risk of both thromboembolic complications and thrombocytopenia. Bivalirudin, a direct thrombin inhibitor, is increasingly being utilized for anticoagulation in the ECMO patient though there is largely a lack of literature within the COVID-19 population. The objective of our study was to evaluate the safety and efficacy of alternative anticoagulation with bivalirudin in patients on ECMO with COVID-19 respiratory failure. METHOD(S): This was a non-interventional retrospective chart review conducted at a single center large community hospital between January 2020 - November 2021. We included both venovenous (VV) and venoarterial (VA) adult ECMO patients anticoagulated with bivalirudin that tested positive for COVID-19. Patients were excluded if their duration of ECMO cannulation was less than 48 hours. Descriptive statistical analyses were performed utilizing median with interquartile range and frequency with percent as appropriate. RESULT(S): Overall, 180 ECMO patients were included in the study. The duration of ECMO cannulation was 29 (9-54) days and our cohort experienced a 42% mortality rate. The rate of thrombotic events including in-circuit thrombosis, arterial and venous thrombotic events was 22%. The median initial platelet count on ECMO was 206 (157-274) and the median nadir was 85 (48-121). ELSO defined major bleeding occurred at a rate of 53% within this cohort. CONCLUSION(S): To our knowledge, this study describes the largest number of patients anticoagulated with bivalirudin for ECMO secondary to COVID-19. Our results suggest similar rates of thrombotic events compared to ELSO registry data. While the half-life of bivalirudin is short, clinicians should still be cautious of bleeding due to lack of a specific reversal agent. Retrospective studies with a comparator cohort, as well as randomized trials are warranted to further evaluate the selection of intravenous anticoagulants in the ECMO population with and without COVID-19.

Distributed Gesture Controlled Systems for Human-Machine Interface

This paper presents the design flow of an IoT human-machine touchless interface. The device uses embedded computing in conjunction with the Leap Motion Controller to provide an accurate and intuitive touchless interface. Its main function is to augment current touchscreen devices in public spaces through a combination of computer vision technology, event-driven programming, and machine learning. Especially following the COVID-19 pandemic, this technology is important for hygiene and sanitation purposes for public devices such as airport, food, and ATM kiosks where hundreds or even thousands of people may touch these devices in a single day. A prototype of the touchless interface was designed with a Leap Motion Controller housed on a Windows PC exchanging information with a Raspberry Pi microcontroller via internet connection. © 2022 IEEE.

Toward Real-World Reproducibility: A Systematic Review and Meta-Analysis of Common Rwd/Rwe Protocol Components

Objectives: Use of real-world data/real-world evidence (RWD/RWE) in the life sciences is accelerating. The FDA has issued draft guidance for the conduct of real-world data-driven studies in clinical development. However, RWD protocol development standards lag, leading to heterogeneity of findings and consequent unreliability of results. The need to address challenges has become urgent due to increasing importance of reliable evidence generation in the COVID-19 pandemic. We performed a systematic review of published RWD protocols to understand current practices to support improvement in standards frameworks. Methods: We extracted protocols referencing RWD from. We defined essential real-world study concepts and mapped them to standard discrete protocol components. We summarized these components, including but not limited to: objectives, operational definitions of endpoints, inclusion/exclusion criteria, patient identification algorithms, schematics, extract/transform/load (ETL) methods, common data model (CDM), safety, analysis, and machine learning (ML)/artificial intelligence (AI). We identified areas of harmonization and disagreement, as well as missing components. Results: The search identified 220 real-world protocols. Despite substantial harmonization in some areas, particularly those components typical to all research studies, there was considerable disagreement regarding the representation of RWD objectives, RWD inclusion/exclusion criteria, data management, ETL, CDM, ML/AI, study design, and statistical analysis. In many cases, studies did not include real-world-specific elements at all. Quantification and statistical attribution of heterogeneity is ongoing. Conclusions: Incorporating best practices and harmonization of protocol development methods and reporting may lead to improved quality, consistency, and reproducibility of studies. The primary limitation of this study was that “real-world” was neither sensitive nor specific as a search term as it is often used imprecisely. Follow-up surveillance studies will quantify and evaluate the impact of improved standards, encompassing all registered observational studies.

A STEM CLIL Pilot Project in Ecuadorian High Schools

Following changes to education regulations in Ecuador, schools have had to increase their English language teaching provision, and CLIL has become a core requirement. As a result, there has been an increase in the number of schools teaching STEM subjects in English to predominantly Spanish-speaking students. Oxford University Press commissioned materials to help support and market their English language STEM textbooks to Ecuadorian schools. Two STEM events were developed, a science show for younger students and a biology workshop for older students. Both projects were piloted successfully. The science shows were launched at four high schools, and the biology workshop was offered as a teacher training event. All of the pilot events were well-received. Unfortunately, the project is currently paused due to schools moving to virtual teaching during the COVID-19 pandemic. However, it is hoped that it can be reinstated when schools fully return to in-person classes. © 2021 IEEE.

Tissue-level alveolar epithelium model for recapitulating SARS-CoV-2 infection and cellular plasticity.

Pulmonary sequelae following COVID-19 pneumonia have been emerging as a challenge; however, suitable cell sources for studying COVID-19 mechanisms and therapeutics are currently lacking. In this paper, we present a standardized primary alveolar cell culture method for establishing a human alveolar epithelium model that can recapitulate viral infection and cellular plasticity. The alveolar model is infected with a SARS-CoV-2 pseudovirus, and the clinically relevant features of the viral entry into the alveolar type-I/II cells, cytokine production activation, and pulmonary surfactant destruction are reproduced. For this damaged alveolar model, we find that the inhibition of Wnt signaling via XAV939 substantially improves alveolar repair function and prevents subsequent pulmonary fibrosis. Thus, the proposed alveolar cell culture strategy exhibits potential for the identification of pathogenesis and therapeutics in basic and translational research.

Safer destinations, healthier staff and happier tourists: opportunities for inclusive water, sanitation and hygiene in tourism. (Special Issue: Consumer experience management and customer journeys in tourism, hospitality and events.)

Sustainable tourism development, including tourism's COVID-19 recovery, requires a holistic view of environmental and community benefits, including access to water, sanitation and hygiene (WASH). This study presents a system-wide Inclusive WASH in tourism framework for destinations. Using a qualitative approach including interviews and focus groups, the framework is applied at three system scales: hotels, the community and wider destination to assess the current WASH situation in Mandalika, Lombok, Indonesia, a water-scarce destination earmarked for rapid development. Findings highlight differences in Inclusive WASH practices between hotels and communities, the potential for conflict and gendered inequalities. Barriers linked to system elements, structure and the enabling environment are identified. Addressing inequitable planning processes, improving stakeholder engagement and creating tools for hotels to improve Inclusive WASH can contribute to improving destination value. Findings are relevant for practitioners, government and community organisations integrating Sustainable Development Gaols 5 and 6 into tourism development and recovery.

Disease and immunoprophylaxis model of human nose organoids to study SARS-CoV-2 and RSV infection

Background. There is a significant and unmet need for pre-clinical models to predict responsiveness of immunotherapies to both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and respiratory syncytial virus (RSV) infection. Airway organoid models have been recently developed to study respiratory viruses;however, the current methods rely on invasive or biopsy derived samples to generate lung or airway organoids. Objective. To establish human nose organoids (HNOs) as a model to study SARS-CoV-2 and RSV pathogenesis and test therapeutics. Methods. We developed a non-invasive method to establish HNOs using stem cells isolated from nasal-wash and mid-turbinate samples. We made air liquid interface (ALI) cultures from undifferentiated 3-dimensional HNOs and differentiated for 21 days to form differentiated nasal epithelium. We inoculated the apical epithelium and assessed SARS-CoV-2 and RSV infection on the apical compartment using real time-polymerase chain reaction, plaque assays and immunofluorescence techniques. We then evaluated the feasibility of HNO-ALI model system to test the efficacy of serum antibodies to prevent SARS-CoV-2 infection and palivizumab monoclonal antibodies to prevent infection using palivizumab sensitive and resistant RSV strains. We introduced the antibodies in the basolateral compartment and monitored its neutralizing capacity on the apical side mimicking the neutralizing effects of antibodies in circulation. Results. Our HNO-ALI cultures consist of well-differentiated, pseudostratified, ciliated, and mucosal respiratory epithelial cells and are susceptible to SARS-CoV-2, RSV A and B infection. SARS-CoV-2 and RSV replicates in the apical ciliated cells of the HNO-ALI cultures, peaks at 4 days, and plateaus at 8 days post infection. Infected HNO-ALI recapitulates aspects of SARS-CoV-2 and RSV disease, including viral shedding, asynchronous cilia beating/ciliary damage, and mucus hyper-secretion. Our model effectively showed protection to infection in a concentration dependent manner of the antibodies used. Conclusion. We established a non-invasive method to generate HNO-ALI epithelial model as an authentic and an alternative model to 1-D cell culture systems. Our ex-vivo HNO-ALI infection model provides a novel approach for testing therapeutic interventions.