CoV-Sym: The development of a psychometrically validated patient reported outcome measure for COVID19

Background: Patient reported outcome measures (PROMs) provide a standardised method to capture patient perspectives which can be used in comparative effectiveness research to inform the evaluation of treatment. Thus far, PROMs have focussed on the long-term sequelae of COVID-19 rather than the acute illness and initial recovery period. Aim(s): To design a psychometrically validated COVID-19 specific PROM to be used in the acute and recovery phase of illness. Method(s): A review of existing literature, evaluation of existing PROMs, input from local experts (n=15) and in-depth qualitative concept elicitation interviews with patients (n=8) were used to create a conceptual framework which informed the generation of items included in the PROM. Cognitive interviews with patients (n=8) were then used to develop and refine the items for inclusion in the PROM and confirm the content and face validity of the draft tool. A nominal group meeting of the expert panel (n=6) was held to confirm the final items for inclusion. Result(s): The CoV-Sym PROM consists of 19 domains and 44 items which are scored using a five-point Likert scale to enable objective measurement of patients' symptomatic recovery from acute COVID-19 illness. Questions address physical, psychological and social domains. Cognitive interviews revealed acceptable content and face validity. Conclusion(s): With the involvement of both patients and experts in the development and validation process, we have created the first COVID-19 specific PROM to measure patient's symptomatic recovery from acute COVID-19 infection. It is ready for further psychometric testing to confirm reliability and responsiveness, the results of which will be presented.

A Case of Anti-Ro52 Antibody Myositis-Associated Interstitial Lung Disease

Introduction: Recognition of myositis-associated interstitial lung disease (ILD) has been increasing due to the recent identification of specific antibodies that are linked to a particular phenotype of myositis-ILD such as antisynthetase syndrome. The anti-Ro52 antibody has been found in multiple connective tissue diseases but its association with ILD is unclear. In fact, the literature on the phenotype of patients with an isolated anti-Ro52 antibody is very scarce. Case Presentation: A 57-year-old retired firefighter with history of gastroesophageal reflux presented to the hospital with a 4-week history of cough and progressive dyspnea with no other symptoms. He had presented to an urgent care facility where he tested negative for SARs-CoV-2 and was given antibiotics and inhalers without a clinical response. Patient required 2L/min of oxygen on admission. He had no other signs of autoimmune disease or other organ involvement. Chest CT showed peripheral ground glass opacities with basilar reticulations and bronchiectasis (Figure 1). WBC and CPK were normal and aldolase was mildly elevated. Initial serologies revealed an ANA 1:320 and a weakly positive p-ANCA with negative PR3/MPO antibodies. Patient was started on prednisone 60 mg and discharged five days later on mycophenolate mofetil (MMF) and 2L/min of oxygen. At 2-week follow-up, his extensive autoimmune panel showed a high titer of Anti-Ro52 antibody. An in depth ILD questionnaire revealed a family history of lupus and the remote use of a short course of steroids 20 years ago after a biceps biopsy showed polymyositis. On chart review, 10 years ago the patient had elevated CPK levels of 255 to 404, in the context of a nonspecific flank pain that resolved without intervention. At his 3-month follow-up, the patient still required 40mg of prednisone, reported dyspnea on exertion and required oxygen with ambulation. Rituximab was added to his regimen and his symptoms significantly improved;at 6-month follow-up, his FVC% improved from 53% to 70% and the patient was no longer on oxygen. Prednisone was titrated down to 10mg and he was continued on MMF 3g/day and Rituximab every 6 months. Discussion: We present a patient with Anti-Ro52 antibody myositisassociated ILD who required 3 immunosuppressive agents to control his disease. This case adds to the very scarce literature on ILD secondary to Anti-Ro52 antibody and highlights the importance of an extensive antibody testing for patients with ILD of unclear etiology, for diagnostic and therapeutic purposes. Further studies describing the phenotype of these patients are warranted. (Figure Presented).

Design at Scale in a First-Year Transdisciplinary Engineering Design Course

Many Canadian engineering faculties employ a first-year design course. Offering a large-scale, realistic and valuable design experience to students beginning to learn about engineering is challenging. In 2020 the Faculty of Engineering (University of Alberta) introduced a new first-year design course for 1200+ qualifying year students: Introduction to Engineering Design, Communication, and Profession. The course is founded on four principles: engineering design is a distinguishing and core feature of engineering practice and education, transdisciplinary engineering design has a common process, sustainability is a key societal goal and integral to engineering design, and the communication of the evaluated design proposition is a necessary step towards design implementation. The course objectives are to introduce first-year students to the transdisciplinary design process and demonstrate differences between the engineering and traditional science programs. The course design had four additional requirements: (1) meet the needs of all our programs;(2) be taught by instructors from each of our disciplines (supporting transdisciplinarity and discipline ownership);(3) engage applied learning;(4) use the design process to solve a community-based problem. The course implementation was supported by two co-lead instructors, the continued involvement of a third design instructor (course co-creator), eight guest instructors (representing all Faculty programs and the provincial professional association), and ten teaching assistants from both engineering and industrial design programs. All course materials (lecture slides, online resources, project descriptions, assessments) were developed in advance. Even as we were implementing this new course, we were collecting midterm feedback, reflecting on and adjusting the course in real-time, and planning the next iteration using a continual improvement process. At the time of original submission, the aim of this paper was to provide insight into the course development, implementation and lessons learned through its delivery. However, with the COVID-19 pandemic, many more challenges faced the instructional team;these are also detailed in this paper.

Evaluation at the nexus: Evaluating sustainable development in the 2020s

Evaluation is finally starting to recognise that humans, and our goals for human development, rights and security rest on our extraction from the natural system. Evaluators have until recently ignored the natural system, which has created a systematic positive and silo reinforcing bias in evaluation and risks rendering evaluation irrelevant for the major issues of the day - extinction and the climate crisis. As evaluation recognises and addresses its responsibilities to contribute to forestalling extinction it will need to mainstream sustainability, meaning that all evaluation will need to start from the nexus with connected human and natural systems. This requires an evaluation capacity and functions that are ready for sustainability. The pathway to evaluation that is sustainability-ready requires that all evaluation undertakings value the natural system and immediately recognise and address important differences between human and natural systems, scale, units of account and connectivity. The knowledge and methods exist in evaluation, social and biophysical sciences. The challenge is therefore not technical but political. It is political because the origins of evaluation and the social sciences on which evaluation rests are in the values and structures that are strongly founded on a claim that humans have dominion over all other things and that all value rests upon human effort. This claim of dominion extends to other, that is, non-European, humans and underpins colonialism and racism. Mainstreaming sustainability will prove challenging and for evaluation to progress it will have to elevate the importance of pursuit of use. The premise of this chapter is that evaluation has an important role in assisting sustainable development efforts get closer to a sustainable and productive nexus where we can make gains in poverty reduction and improve the environment in the present, thereby contributing to a sustainable and better future. Much has changed in the six years since the first edition of this volume was published. The inextricable connection between human and natural systems has been demonstrated with increasing intensity and frequency;wildfires, drought, flooding, cyclones and most recently the Covid-19 pandemic are translating the repeated forecasts and warnings of impending climate and sustainability crises into indisputable realities. What was termed climate change five years ago is now framed as climate crisis or extinction. We are clearly reaching the limits to extraction from the natural system, limits beyond which there does not appear to be a return. We also appear to be reaching new limits to the ability of capital to increase exploitation through increasing technology, destruction of labour and social protections, globalisation and state capture. © 2021 selection and editorial matter, Juha I. Uitto;individual chapters, the contributors.

Responding to an international crisis: The adaptability of the practice of work-integrated learning

The impact of the COVID-19 pandemic on the practice of work-integrated learning (WIL) has been significant, with many active WIL activities pivoting to remote offerings where students engage with the workplace through online platforms from their homes. The pandemic has also caused significant and ongoing disruption to the economy, likely causing less work placement opportunities for upcoming years within the context of limited institutional budgets and resourcing. It is, therefore, vitally important that institutions develop diverse practices of WIL and shift away from a heavy reliance on work placements. Developing diverse WIL practices across educational institutions is an important strategy to build 'institutional WIL resilience' during times of disrupted economies with limited WIL opportunities. During the pandemic, the use of simulations had increased, in particular, in relation to preparing students for WIL, however, caution is needed in considering simulations as a comparable alternative to WIL. © 2020 International Journal of Work-Integrated Learning. All rights reserved.