Disaster impacts, resilience, and sustainability opportunities for Gili Trawangan, Indonesia: transdisciplinary reflections following COVID-19.

This paper contains transdisciplinary reflections from both scientists and local NGO (nongovernmental organisation) managers on the international small island tourism destination of Gili Trawangan, Indonesia. These viewpoints centre on the impacts of, as well as the short- and long-term adaptation strategies and sustainability opportunities associated with, two disasters that occurred in rapid succession: the earthquakes that struck Lombok in 2018; and the COVID-19 pandemic that began in 2020. A brief review of the governance challenges facing Gili Trawangan sets up the analysis of the findings and the presentation of new empirical insights into how the island's communities have dealt with two unique disaster scenarios over the past three years. The paper draws on a community resilience framework premised on social capital and collective action theories to position the island's ability to transition towards sustainable tourism in the wake of the COVID-19 pandemic. It concludes by laying out sustainability opportunities going forward.

Investigating the Impact of Occupational Technostress and Psychological Restorativeness of Natural Spaces on Work Engagement and Work-Life Balance Satisfaction.

The COVID-19 pandemic has necessitated lockdowns and mandatory working from home, as well as restrictions on travel and recreation. As a result, many people have had to use their home as an office and have increased their use of Information Communications Technology (ICT) for work purposes. Nature and accessing natural spaces are known to be beneficial for human health and wellbeing, as a result of their restorative properties. Access to local outdoor spaces was permitted under restrictions, and use of such spaces increased during lockdown. This survey study investigated whether the perceived restorativeness of natural spaces and exposure to technostress predicted the levels of work engagement and work-life balance satisfaction (WLBS) during the period of COVID-19 restrictions adopted in 2020. Analyses conducted on a sample of 109 people employed in the UK revealed that technostress negatively impacted WLBS, whilst perceived psychological restorativeness positively predicted work engagement. The study highlights the benefits of having access to natural spaces to improve employees' work engagement and potentially negate the negative effects of technostress, particularly during a period of intensive working from home. The results contribute to the understanding of the linkages between restorativeness and work engagement, paving the way for synergies across these research fields.

Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery.

The COVID-19 pandemic mandated a substantial switch in primary health care delivery from an in-person to a mainly remote telephone or video service. As the COVID-19 pandemic approaches its third year, limited progress appears to have been made in terms of policy development around consultation methods for the post-acute phase of the pandemic. In September 2020, the International Primary Care Respiratory Group convened a global panel of primary care clinicians - including family physicians, paediatricians, pharmacists, academics and patients - to consider the policy and health management implications of the move to remote consultations in the primary care setting. The group gave special consideration to how and how far remote consultations should be integrated into routine primary health care delivery. Remote consultations can be a useful alternative to in-person consultations in primary care not only in situations where there is a need for viral infection control but also for the routine delivery of chronic disease management. However, they may not be more time efficient for the clinician, and they can add to the workload and work-related stress for primary care practitioners if they remain the dominant consultation mode. Remote consultations are also less appropriate than in-person consultations for new disease diagnosis, dealing with multiple issues and providing complex care. Ensuring health care professionals have the appropriate skill set to effectively deliver remote consultations, administrative and/or IT support and appropriate reimbursement will be key to achieving optimal integration of remote consultations into routine clinical practice. Addressing digital access and digital literacy issues at a societal level will also be essential to ensure individuals have fair and equitable access to the internet and sufficient security for exchange of personal and health-related data.

Community lung health service design for COPD patients in China by the Breathe Well group.

COPD is increasingly common in China but is poorly understood by patients, medications are not used as prescribed and there is no access to recommended non-pharmacological treatment. We explored COPD patients' and general practitioners' (GPs) knowledge of COPD, views on its management and the acceptability of a flexible lung health service (LHS) offering health education, exercise, self-management, smoking cessation and mental health support. Using a convergent mixed methods design, data were collected from patients and GPs using focus groups (FGs) in four Chinese cities, questionnaires were also used to collect data from patients. FGs were audio-recorded and transcribed. Quantitative data were analysed descriptively, thematic framework analysis was used for the qualitative data. Two-hundred fifty-one patients completed the questionnaire; 39 patients and 30 GPs participated in ten separate FGs. Three overarching themes were identified: patients' lack of knowledge/understanding of COPD, current management of COPD not meeting patients' needs and LHS design, which was well received by patients and GPs. Participants wanted COPD education, TaiChi, psychological support and WeChat for social support. 39% of survey responders did not know what to do when their breathing worsened and 24% did not know how to use their inhalers. 36% of survey respondents requested guided relaxation. Overall, participants did not fully understand the implications of COPD and current treatment was sub-optimal. There was support for developing a culturally appropriate intervention meeting Chinese patients' needs, health beliefs, and local healthcare delivery. Further research should explore the feasibility of such a service.

Stability testing of the Pfizer-BioNTech BNT162b2 COVID-19 vaccine: a translational study in UK vaccination centres.

OBJECTIVE: The roll-out of the Pfizer-BioNTech BNT162b2 COVID-19 vaccine has brought many logistical challenges, such as the absence of comprehensive stability data leading to strict handling instructions during dilution and administration. Accidental mishandling therefore presents challenging clinical dilemmas, which often led vaccine providers to err on the side of caution and discard mishandled vials rather than risk administering ineffective vaccine. This study aims to answer key questions about the vaccine's stability to allow for a more informed decision-making process should a non-conformity occur. METHODS: Residual vaccine in freshly used, but appropriately stored vials collected from vaccination centres in Brighton, UK, were tested after exposure to various handling conditions and analysed by dynamic light scattering to determine the size of the lipid-mRNA nanoparticles, and gel electrophoresis to visualise the mRNA integrity and separation from the lipid formulation. RESULTS: Knocking or dropping vaccine samples from small heights resulted in lowest levels of instability, indicating low risk of compromising clinical efficacy. However, repeated drawing and injecting through 23 G needles at high speed and, more significantly, shaking and vortexing led to progressive increase in the size and polydispersity index of the lipid-mRNA nanoparticles, coupled with or caused by up to ~50% release of mRNA from the lipid formulation. This is thought to impact the vaccine's efficacy due to lack of free mRNA protection and cellular internalisation. CONCLUSIONS: These results reiterate the importance of adhering to the manufacturer's instructions on handling, especially with regard to shaking and exposing the vaccine to excessive vibration.