A Competing Stimuli Intervention Package to Treat Automatically Reinforced Destructive Behavior

Behaviors maintained by automatic reinforcement are often more difficult to treat due to difficulty with identifying the relevant maintaining variable(s). One common intervention to treat automatically maintained behavior includes competing stimuli. Competing stimuli promote item engagement which may replace challenging behavior (i.e., response competition). Competing stimuli have shown to be a widely successful intervention across diverse topographies of challenging behavior;however, few studies have evaluated the use of competing stimuli on destructive behavior. The purpose of the current study was to treat automatically maintained destructive behavior with a competing stimuli intervention package for an adolescent with developmental disabilities. Results showed a decrease in destructive behavior when access to competing stimuli was a component of an intervention package in a clinic setting. Also, preliminary data are provided showing treatment effects when caregivers implemented the intervention. Due to the complexity of the final intervention package, recommendations for clinicians are provided which focus on improving feasibility, practicality, and sustainability of treatment components.Copyright © The Author(s) 2022.

RISING TO THE CHALLENGE: ORTHOGERIATRIC SERVICE IMPROVEMENT AND COVID-19

Background: Nationally agreed hip fracture standards have contributed to the improvement of outcomes in hip fracture patients. In 2020, our hospital was awarded “The Golden Hip” for achieving highest compliance with Irish Hip Fracture Standards (IHFS) nationally for 2019. Methods: Data from the Irish Hip Fracture Database (IHFD)was retrospectively analysed to assess our performance in 2020 versus 2019 in hip fracture patients over sixty. Multiple quality improvement interventions were put in place throughout 2019 to ensure improvement in IHFS1-6 compliance: Creation of the Hip Fracture Pathway Subgroup, IHFS 1 Breaches Audit, Orthogeriatric input at Orthopaedic inductions, weekly Multi-disciplinary Team meetings, a Nutritional Hip Fracture Pathway and addition of the Fracture Liaison Service Advanced Nurse Practitioner. Results: There were 239 hip fracture patients in 2020 vs 249 in 2019. IHFS1 compliance improved with the percentage of patients admitted to the Orthopaedic ward within 4 hours increasing to 71% in 2020 from 56% in 2019. There was improvement in IHFS2-time to surgery <48 hours- 66% in 2020 vs 60% in 2019. IHFS3-pressure ulcer rate-was at the national average, 3% in 2020 vs 2% in 2019. IHFS4 (reviewed by a Geriatrician), IHFS5 (received a bone health assessment) and IHFS6 (received a specialised falls assessment) were lower overall;87% in 2020 vs 98% in 2019. For all quarters (Q),43% of patients met all IHFS in our hospital in 2020 vs 32% in 2019, resulting in €90,000 in Best Practice Tariff funding. Conclusion: Lower results for IHFS 4,5 and 6 reflect the arrival of the COVID-19 pandemic which led to redeployment of the Orthogeriatric Service and redeployment of the MDT from end of Q1 to Q3. When services in 2020 were preserved,1 in 2 hip fracture patients met all IHFS, vs 1 in 3 patients in 2019. Despite the pandemic, we continued to achieve the highest level of IHFS compliance nationally, being awarded a second consecutive “Golden Hip” for 2020.

CONTINUING TO ‘BE HIP’: ORTHOGERIATRIC SERVICE IMPROVEMENTS IN 2021

Background: Scotland first demonstrated that adherence to nationally agreed hip fracture standards improve patient survival, reduces the duration of admission, and reduces the need for high dependency care. Our study aims to assess adherence to the Irish Hip Fracture Standards (IHFS) in our hospital for 2021 amidst the COVID-19 pandemic, translating to improved clinical outcomes for our patients. Methods: The IHF database was retrospectively analysed, comparing quarters 1-4 in 2021 with our 2020 results. Results: IHFS1, patient time to the ward < 4hours, was maintained at 67% in 2021 versus 71% overall in 2020. There was improvement in IHFS2, time to surgery within 48 hours, up to 73% in 2021 versus 66% in 2020. IHFS3 was 4% in 2021 versus 3% overall in 2020. Further improvements were noted for IHFS4, with 95% of patients reviewed by a Geriatrician in 2021 versus 87% in 2020. IHFS5 also improved with 97% of patients receiving a bone health assessment in 2021 versus 87% in 2020. Moreover, IHFS6, improved with 97% of patients undergoing a specialised falls assessment in 2021 versus 87% in 2020. Conclusion: The improvement in 2021 figures is reflective of the return of redeployed services during the COVID-19 pandemic inclusive of the Orthogeriatric Service, the Fracture Liaison Service Advanced Nurse Practitioner, the Trauma Co-ordinator, and the specialist Orthopaedic ward complete with its Orthopaedic nurses and Multi-Disciplinary Team, and improved Emergency Department pathways. These continued improvements in the IHFS further emphasise that success is dependent on a team that is joined at the hip

Australian Public Universities: A crisis of governance*

In dialogue with other articles within this special issue, in this article we argue that the financial crisis triggered by the onset of COVID-19 is revealing a failed governance structure within Australian public universities that has ultimately enabled the conditions that led to the crisis currently before us. We suggest that the impact of COVID-19 has laid bare a series of problems that were in the process of unfolding years before the pandemic hit. Finally, we will examine this failure of leadership through the lens of the statutory nature and governance structures of Australian public universities, cast against the current rhetoric that metaphorically equates universities with commercial corporations, to determine the extent to which such a metaphor is accurate, and ultimately (we contend) detrimental to an effective and efficient university sector.

A Brief History of Australian Universities*

This article aims, firstly, to provide a sketch of the humanistic tradition of education from Classical Antiquity through to the present, as the cultivation of the whole person as an individual and as a responsible citizen, which arguably still underpins European and other western education systems but which has been eroded in Australia. Secondly, this article aims to provide an outline history of universities in Australia from 1850 to the present, highlighting by way of examples consistent patterns and failures, and the sources of challenges now facing the sector. Thirdly, this article provides a brief summary of those challenges, some of which have been exacerbated but not caused by COVID-19.

Increasing Computational Protein Design Literacy through Cohort-Based Learning for Undergraduate Students

Undergraduate research experiences can improve student success in graduate education and STEM careers. During the COVID-19 pandemic, undergraduate researchers at our institution and many others lost their work- study research positions due to interruption of in-person research activities. This imposed a financial burden on the students and eliminated an important learning opportunity. To address these challenges, we created a paid, fully remote, cohort based research curriculum in computational protein design. Our curriculum used existing protein design methods as a platform to first educate and train undergraduate students and then to test research hypotheses. In the first phase, students learned computational methods to assess the stability of designed protein assemblies. In the second phase, students used a larger data set to identify factors that could improve the accuracy of current protein design algorithms. This cohort based program created valuable new research opportunities for undergraduates at our institute and enhanced the undergraduates' feeling of connection with the lab. Students learned transferable and useful skills such as literature review, programming basics, data analysis, hypothesis testing, and scientific communication. Our program provides a model of structured computational research training opportunities for undergraduate researchers in any field for organizations looking to expand educational access.

The patient experience and clinical efficacy of a novel virtual c13ubt service at an irish tertiary referral center during the covid 19 pandemic

Introduction: UBT is the most accurate non-invasive test for H.pylori infection. The orally given urea, labelled with C13, is hydrolysed by the enzyme urease of H.pylori and C13O2 is measured expired in breath. UBT was our gold standard diagnostic test for H.pylori. This practice changed abruptly in March 2020, when our first wave of coronavirus -2 (SARS-CoV-2) started. UBT carries the risk of contamination by SARS-CoV-2 in the aerosol droplets generated by exhaled air. The British Society of Gastroenterology guideline at that time graded UBT as Aerosol Generating Procedure and therefore at high risk for transmission. Only emergency gastroenterology high risk procedures were recommended during restrictions which effectively terminated our standard UBT service. To maintain a non-invasive diagnostic option we developed a novel virtual test. C13 UBT At Home, is performed by patients at home with step by step instructions involving live video conference interaction between the patients and technicians. Aims & Methods: To determine the acceptability and the accuracy of the novel C13 UBT At Home service. Patients on a UBT waiting list were contacted and invited to undergo the alternative virtual breath test. Willing participants were pre assessed over phone to explain the process. Technical aspects (internet, smart phone or laptop requirements), navigation through the video call system attendanywhere and routine clinical parameters including PPI and antibiotic use were discussed. Suitable patients collected a Home UBT kit (Patient information sheet, test documentation, pre and post collection tubes, collection straw, urea tablet and feedback questionnaire) from a drop off point up to a week prior to their scheduled appointment. The test was performed as standard by the patient at home with live interaction for all active steps. The 20 minute rest between samples 1 and 2 collection was offline which allowed technicians to do concurrent cases. Patients were requested to fill in a feedback questionnaire after the test and to return it with the samples to the drop off point within 48 hours for analysis. The questionnaire included 6 questions covering pre procedure, procedure and post procedure domains. In addition to patient satisfaction, positivity rate, sample error rate and activity numbers were compared between UBT at home and a standard UBT cohort which was reinstated in 2021. Results: 300 patients were enrolled, mean age 41 years (range 7-85), 177 female (59%). Overall response rate was 96% (288), 96% (285) rated the entire UBT at home process as either excellent or good. All other parameters except connection to the hospital video call system, which was subject to external factors were also rated excellent/good by >90%. Accuracy between UBT tests was similar: positivity rate 23% (69/299) versus 22% (74/326), sample error rate 0.33% (1/300) versus 0.6% (2/326) for the UBT at home and standard tests respectively. Currently 3 of every 4 UBT's is now virtual despite reduced restrictions. Conclusion: UBT at home is possible and acceptable to patients with equivalent accuracy to standard UBT and should be continued to improve patient choice and satisfaction.

Food salvaging to alleviate hunger and food insecurity: the role of mobile technology

This article aims to discuss the role of a novel app, called Food2Share, developed at New York University (NYU). The study describes the potential of the app to alleviate hunger and food insecurity and simultaneously reduce food waste. The app is an example of a digital marketplace, designed to connect stakeholders and local communities, to help vulnerable New York City populations to obtain food. The app will be instrumental in scaling up efforts to combat food insecurity and to provide safe and nutritious foods through widespread local community outreach. Lastly, the study discusses how the Food2Share app may be adapted for global settings- particularly relevant during the COVID-19 pandemic. The Public Health Nutrition research group and technology experts at New York University have partnered to develop a prototype app, Food2Share, which connects food-insecure individuals with food establishments. Food salvaging is a strategy to recover food that would otherwise go to waste from restaurants, supermarkets and other food establishments and redistribute it to local food programmes and communities. The aim of the app is to improve and scale up food salvaging and redistribution efforts. To ensure that everyone has access to sufficient food, they must innovate by developing technology-enabled initiatives to increase food security and reduce food waste. Public-private partnerships can yield initiatives that can be replicated globally. Digital platforms need to be piloted to ensure that they are scalable and sustainable. Evaluation must ensure access to vulnerable, food-insecure populations. During the COVID-19 pandemic, with food establishments forced to close, many owners have risen to the challenge of providing food to those in need and to front-line responders through grassroots food-distribution initiatives. Scaling up these initiatives using technology and applying them to the global context could expand the efforts they have witnessed during the crisis. The Food2Share app is one illustration of a community initiative that connects food-insecure individuals with food establishments with excess prepared food and individuals willing to engage in helping those in need.

SO-1 The impact of COVID-19 on daily practice patterns in the third-line setting for patients with metastatic colorectal cancer: Results of a real-world survey

Background: The emergence of the COVID-19 virus in 2020 led to unprecedented challenges in the way oncologic care is organized to guarantee treatment continuation for patients with cancer. The SCOPE COVID-19 survey aimed to assess the impact of the COVID-19 pandemic on third-line treatment goals in patients with metastatic colorectal cancer (mCRC) and compare it with daily practice patterns from the pre–COVID-19 era. Methods: An expert panel of gastrointestinal oncologists developed the survey, which was undertaken between October 2020–January 2021. Questions were designed to evaluate the practice patterns during this time and assess the future impact of COVID-19 on treatment decisions. The survey was conducted online using FocusVision Decipher. Oncologists from 14 countries, the majority of which were in Europe, participated. Results: As of 31 January 2021, there were 228 respondents. The majority were medical oncologists (89%), aged between 35–55 years (62%), practiced in a university hospital (49%), and saw between 10–29 patients with mCRC/month (53%). Overall, few restrictions affecting cancer patient management, such as staff being redeployed, were reported by the majority of oncologists (84%). That said, there were a number of changes to practice patterns: the most frequent were a reduction in the number of hospital visits (83%), increased use of virtual consultations/telemedicine (82%), increased frequency of prescribing oral versus intravenous (IV) treatments (73%), and an increase in follow-up/monitoring procedures done closer to home (73%). The third-line treatment goals remained similar to the pre-COVID era;preserving quality of life remained the singular most common primary goal (36%), while 42% of respondents cited efficacy-focused goals, such as prolonging overall survival and improving progression-free survival as their main aim. Overall, 93% of oncologists opined that treatment decisions over the next 12 months will be influenced by the pandemic. While 86% predicted a return to normal for the initial visits for new patients, thereafter and for ongoing patients, 83% foresee that there will be a continued increase in the use of virtual consultations/telemedicine, 80% envision reduced frequency of hospital visits, and 74% foresee the increased frequency of prescribing oral versus IV treatments to be maintained, as well as follow-up being undertaken closer to home. In total, 40% of oncologists believe that the changes to existing protocols, incurred as a result of the pandemic, will be in effect for at least a year. Conclusions: The main third-line treatment goals for patients with mCRC remained the same during the COVID-19 pandemic. However, there were changes to the daily practice patterns. There was an increased use of oral versus IV therapies, and more follow-up and monitoring procedures were undertaken closer to home. Patients visited hospitals less frequently, with a shift toward virtual consultations/telemedicine, practices that are thought to continue for the foreseeable future. The latter observation suggests there is a need to further develop and invest in all aspects of digital health. Editorial acknowledgement: Medical writing support was provided by Joanne Franklin, PhD, CMPP, from Aptitude Health, The Hague, the Netherlands, and funded by Les Laboratoires Servier, France. Legal entity responsible for the study: The authors. Funding: Les Laboratoires Servier, France. Disclosure: G. Prager: Advisory / Consultancy: Merck, Roche, Amgen, Sanofi, Lilly, Bayer, Servier, Taiho, CECOG, MSD, BMS, Pierre Fabre. F. Rivera Herrero: Honoraria (Institution): Roche, Merck-Serono, Amgen, Sanofi, MSD, BMS, Servier;Advisory / Consultancy: Roche, Merck-Serono, Amgen, Sanofi, MSD, BMS, Servier;Research grant / Funding (self): Roche, Merck-Serono, Amgen, Sanofi, MSD, BMS, Servier;Research grant / Funding (institution): Roche, Merck-Serono, Amgen, Sanofi, MSD, BMS, Servier. H. Wasan: Honoraria (self): Servier, Incyte, Pierre Farbre;Advisory / Consultancy: Servier, Incyte, Pierre Farbre;Speaker Bure u / Expert testimony: Servier, Incyte, Pierre Farbre;Research grant / Funding (institution): Pfizer, Sirtex;Travel / Accommodation / Expenses: Servier, Incyte, Pierre Farbre. All other authors have declared no conflicts of interest.

Fire, pestilence and the extractive economy: cultural policy after cultural policy

Australia has witnessed long-standing cuts in the arts and culture federal budget. Most recently, the disappearance of the arts portfolio into a “super-ministry” along with infrastructure, transport, regional development and communications further signals the lack of support, both ideologically through public rhetoric, and financially through (absent) support packages, the current federal government holds towards the arts and arts workers. This paper accounts for how such ideological fractures have underserved freelancers, casuals, temporary and part-time workers in the arts who missed out on the critical initial support packages, and how state governments were more willing to make up for this initial shortfall. This paper further accounts for how the federal government lacks the necessary understanding of working patterns of those engaged in creative occupations, and over emphasizes funding bailouts for primary industry. This also has broader implications for how women are disproportionately impacted by sectors the federal government chooses to support. © 2020 Informa UK Limited, trading as Taylor & Francis Group.

“A Plague upon Your Howling”: art and culture in the viral emergency

In this introduction, we outline the context for the international emergence of cultural policy responses to the COVID-19 pandemic. Our article first offers a general account of how arts and culture have been affected by the pandemic, before looking at some of the state interventions (bailouts’) to support the professional sector, and the present and future conditions they might be seeking to preserve or occasion. We then examine the UK as a particular case study. In rejecting a politics of “bailout” and “return”, and in synchrony with others seeking to situate culture in a re-vitalised political economy, we argue that professional arts and culture needs to move forward with a “new deal” in hand;one that can enhance culture’s potential and multipart value, as well as help the sector progressively engage with the many social, economic and environmental challenges ahead and beyond C-19. © 2020 Informa UK Limited, trading as Taylor & Francis Group.