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Muhammad B Qureshi,1 Jose O Garcia,1 Jaxon Quillen,2 Carolyn Mead-Harvey,2 Christina Wentz,3 Cherie B Nau,4 Muriel Schornack,4 Keith Baratz,4 Sanjay V Patel,4 Joanne Shen5 1Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA; 2Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA; 3Illinois College of Optometry, Chicago, IL, USA; 4Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 5Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, USACorrespondence: Joanne Shen, Department of Ophthalmology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA, 85259, Tel +1 480-301-8085, Fax +1 480-301-7326, Email shen.joanne@mayo.eduPurpose: To compare baseline characteristics and treatment of chronic ocular graft-versus-host disease (oGVHD) patients in two treatment locations.Patients and Methods: Patients diagnosed with definite chronic oGVHD between September 1, 2014 and September 20, 2021 at two locations were identified. IRB-approved retrospective chart review was conducted for the following data: demographic information, ocular surface disease index (OSDI), corneal fluorescein staining (CFS), and treatment(s) used. Differences by site were assessed using Pearson’s Chi-Square tests and two-sample t-tests; differences by time were assessed using paired t-tests.Results: At baseline, Clinic 1 (C1) patients had a worse mean OSDI score (47.8 vs 36.3, p = 0.011) and CFS in both OD (1.3 vs 0.8, p = 0.005) and OS (1.3 vs 0.6, p < 0.001) compared to Clinic 2 (C2). Comparing baseline to endpoint, C1 patients experienced an improvement in OSDI (− 17.26, p < 0.001), CFS OD (− 0.50, p < 0.001), and CFS OS (− 0.51, p < 0.001) at C1. Change in OSDI, CFS OD, or CFS OS was not statistically significant at C2. Despite similar follow-up length, C1 demonstrated more clinic visits (10.4 vs 3.4, p < 0.001) and more treatment trials (4.9 vs 2.4, p < 0.001) compared to C2. Punctal plugs (85.5% vs 61.2%, p = 0.002), punctal cautery (69.7% vs 28.6%, p < 0.001), topical steroids (72.4% vs 22.4%, p < 0.001), and autologous serum tears (AST) (52.6% vs 8.2%, p < 0.001) were used more frequently at C1 than at C2.Conclusion: oGVHD patients at C1 experienced significant improvement in OSDI and corneal fluorescein staining and compared to patients at C2, had more frequent follow-up and use of punctal plugs, punctal cautery, topical steroids, and AST.Keywords: graft-versus-host disease, GVHD, chronic GVHD, dry eye disease, ocular GVHD, keratoconjunctivitis sicca, KCS

Abstract Background Publicly funded clinical trials require a substantial commitment of time and money. To ensure that sufficient numbers of patients are recruited it is essential that they address important questions in a rigorous manner and are managed well, adopting effective marketing strategies. Methods Using methods of analysis drawn from management studies, this paper presents a structured assessment framework or reference model, derived from a case analysis of the MRC's CRASH trial, of 12 factors that may affect the success of the marketing and sales activities associated with clinical trials. Results The case study demonstrates that trials need various categories of people to buy in – hence, to be successful, trialists must embrace marketing strategies to some extent. Conclusion The performance of future clinical trials could be enhanced if trialists routinely considered these factors.

Abstract Background Securing and managing finances for multicentre randomised controlled trials is a highly complex activity which is rarely considered in the research literature. This paper describes the process of financial negotiation and the impact of financial considerations in four UK multicentre trials. These trials had met, or were on schedule to meet, recruitment targets agreed with their public-sector funders. The trials were considered within a larger study examining factors which might be associated with trial recruitment (STEPS). Methods In-depth semi-structured telephone interviews were conducted in 2003–04 with 45 individuals with various responsibilities to one of the four trials. Interviewees were recruited through purposive and then snowball sampling. Interview transcripts were analysed with the assistance of the qualitative package Atlas-ti. Results The data suggest that the UK system of dividing funds into research, treatment and NHS support costs brought the trial teams into complicated negotiations with multiple funders. The divisions were somewhat malleable and the funding system was used differently in each trial. The fact that all funders had the potential to influence and shape the trials considered here was an important issue as the perspectives of applicants and funders could diverge. The extent and range of industry involvement in non-industry-led trials was striking. Three broad periods of financial work (foundation, maintenance, and resourcing completion) were identified. From development to completion of a trial, the trialists had to be resourceful and flexible, adapting to changing internal and external circumstances. In each period, trialists and collaborators could face changing costs and challenges. Each trial extended the recruitment period; three required funding extensions from MRC or HTA. Conclusion This study highlights complex financial aspects of planning and conducting trials, especially where multiple funders are involved. Recognition of the importance of financial stability and of the need for appropriate training in this area should be paralleled by further similar research with a broader range of trials, aimed at understanding and facilitating the conduct of clinical research.

Abstract Background A commonly reported problem with the conduct of multicentre randomised controlled trials (RCTs) is that recruitment is often slower or more difficult than expected, with many trials failing to reach their planned sample size within the timescale and funding originally envisaged. The aim of this study was to explore factors that may have been associated with good and poor recruitment in a cohort of multicentre trials funded by two public bodies: the UK Medical Research Council (MRC) and the Health Technology Assessment (HTA) Programme. Methods The cohort of trials was identified from the administrative databases held by the two funding bodies. 114 trials that recruited participants between 1994 and 2002 met the inclusion criteria. The full scientific applications and subsequent trial reports submitted by the trial teams to the funders provided the principal data sources. Associations between trial characteristics and recruitment success were tested using the Chi-squared test, or Fisher's exact test where appropriate. Results Less than a third (31%) of the trials achieved their original recruitment target and half (53%) were awarded an extension. The proportion achieving targets did not appear to improve over time. The overall start to recruitment was delayed in 47 (41%) trials and early recruitment problems were identified in 77 (63%) trials. The inter-relationship between trial features and recruitment success was complex. A variety of strategies were employed to try to increase recruitment, but their success could not be assessed. Conclusion Recruitment problems are complex and challenging. Many of the trials in the cohort experienced recruitment difficulties. Trials often required extended recruitment periods (sometimes supported by additional funds). While this is of continuing concern, success in addressing the trial question may be more important than recruitment alone.

Abstract Background The results of a qualitative study carried out in four developing countries (Cuba, Thailand, Saudi Arabia and Argentina) are presented. The study was conducted in the context of a randomised controlled trial to test the benefits of a new antenatal care protocol that reduced the number of visits to the doctor, rationalised the application of technology, and improved the provision of information to women in relation to the traditional protocol applied in each country. Methods Through focus groups discussions we were able to assess the concepts and expectations underlying women's evaluation of concepts and experiences of the care received in antenatal care clinics. 164 women participated in 24 focus groups discussion in all countries. Results Three areas are particularly addressed in this paper: a) concepts about pregnancy and health care, b) experience with health services and health providers, and c) opinions about the modified Antenatal Care (ANC) programme. In all three topics similarities were identified as well as particular opinions related to country specific social and cultural values. In general women have a positive view of the new ANC protocol, particularly regarding the information they receive. However, controversial issues emerged such as the reduction in the number of visits, particularly in Cuba where women are used to have 18 ANC visits in one pregnancy period. Conclusion Recommendations to improve ANC services performance are being proposed. Any country interested in the application of a new ANC protocol should regard the opinion and acceptability of women towards changes.

Abstract Background This study assessed women and providers' satisfaction with a new evidence-based antenatal care (ANC) model within the WHO randomized trial conducted in four developing countries. The WHO study was a randomized controlled trial that compared a new ANC model with the standard type offered in each country. The new model of ANC emphasized actions known to be effective in improving maternal or neonatal health, excluded other interventions that have not proved to be beneficial, and improved the information component, especially alerting pregnant women to potential health problems and instructing them on appropriate responses. These activities were distributed within four antenatal care visits for women that did not need any further assessment. Methods Satisfaction was measured through a standardized questionnaire administered to a random sample of 1,600 pregnant women and another to all antenatal care providers. Results Most women in both arms expressed satisfaction with ANC. More women in the intervention arm were satisfied with information on labor, delivery, family planning, pregnancy complications and emergency procedures. More providers in the experimental clinics were worried about visit spacing, but more satisfied with the time spent and information provided. Conclusions Women and providers accepted the new ANC model generally. The safety of fewer visits for women without complications with longer spacing would have to be reinforced, if such a model is to be introduced into routine practice.

Even highly trained behaviors demonstrate variability, which is correlated with performance on current and future tasks. An objective of motor learning that is general enough to explain these phenomena has not been precisely formulated. In this six-week longitudinal learning study, participants practiced a set of motor sequences each day, and neuroimaging data were collected on days 1, 14, 28, and 42 to capture the neural correlates of the learning process. In our analysis, we first modeled the underlying neural and behavioral dynamics during learning. Our results demonstrate that the densities of whole-brain response, task-active regional response, and behavioral performance evolve according to a Fokker-Planck equation during the acquisition of a motor skill. We show that this implies that the brain concurrently optimizes the entropy of a joint density over neural response and behavior (as measured by sampling over multiple trials and subjects) and the expected performance under this density; we call this formulation of learning minimum free energy learning (MFEL). This model provides an explanation as to how behavioral variability can be tuned while simultaneously improving performance during learning. We then develop a novel variant of inverse reinforcement learning to retrieve the cost function optimized by the brain during the learning process, as well as the parameter used to tune variability. We show that this population-level analysis can be used to derive a learning objective that each subject optimizes during his or her study. In this way, MFEL effectively acts as a unifying principle, allowing users to precisely formulate learning objectives and infer their structure.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2007.01019.x Byline: Julia Frost (1), Harriet Bradley (2), Ruth Levitas (2), Lindsay Smith (3), Jo Garcia (4) Keywords: miscarriage; bereavement; death; motherhood; pregnancy; scientisation Abstract: Abstract This paper explores the special nature of bereavement in the case of first trimester miscarriage. It is theoretically informed by the sociological literature concerning death and bereavement and is empirically grounded in interviews with 79 women. We argue that the 'scientisation of death' in modern societies contributes to the uncertainty and isolation which distinguish early miscarriage as a unique form of loss. In the absence of clear cultural scripts to draw upon, many women interviewed gave meaning to their loss as 'what might have been' or what we call 'the loss of possibility'. Some women juxtaposed the failure of their pregnancy with that of modern medicine either to prevent the loss or provide a credible explanation for their miscarriage. Little research has been conducted in this area, since the pioneering work of Lovell (1983) and Cecil (1984). Our research draws on one of the largest and most systematic bodies of data ever collected on early miscarriage, and provides continued evidence of the traumas of miscarriage. The strategies employed by women to make sense of, and come to terms with, their experience of miscarriage are explored, employing a typology of pre-modern, modern and postmodern responses. Author Affiliation: (1)School of Nursing and Community Studies, University of Plymouth (2)Department of Sociology, University of Bristol (3)East Somerset Research Consortium (ESReC) (4)Social Science Research Unit, Institute of Education, University of London Article note: Address for correspondence: Harriet Bradley, Department of Sociology, University of Bristol, 12 Woodland Road, Bristol BS8 1UQ. e-mail: harriet.bradley@bristol.ac.uk

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.10.008 Byline: Claire Snowdon, Diana Elbourne, Jo Garcia Keywords: Random controlled trials; Decision-making; Perinatal trials; Parents; United Kingdom Abstract: For some perinatal trials, parents can be asked to make important decisions about trial participation within limited timeframes in highly stressful circumstances. This qualitative study explores the pace of decision-making for 78 parents associated with one or more of four such trials in the UK. The themes associated with rapid decisions were concern for their baby, reactions to staff, and perceptions of the benefits and risks associated with the trial. Those who took longer to decide whether or not to participate often described similar emotions to those who made rapid decisions, but their slower decisions were because more time was available, they wanted further discussion or they found the decision particularly difficult. The majority of those who made rapid decisions felt that there were no risks associated with the trial in question, in contrast to the majority of those who made slower decisions who felt there were risks. The parents did not appear to view rapid decisions as problematic. Although there was evidence of parental vulnerability in each trial context, they largely felt that they acted swiftly and responsibly in the best interests of their child in accordance with the timeframes that were set for them. Author Affiliation: London School of Hygiene and Tropical Medicine, London, UK

Randomized controlled trials (RCTs) are widely accepted by the scientific community as the most rigorous way of evaluating interventions in health care. Although their central feature, random allocation of treatment, is generally seen as methodologically appropriate, its application has caused much debate amongst health professionals and ethicists. This paper describes the views of parents who consented that their critically ill newborn baby should be enrolled in a neonatal trial. In-depth interviews were used to determine their responses to the trial and randomization. The nature of the trial was often poorly understood. The random basis of the allocation of treatment and the rationale behind this approach were also problematic issues. Some parents did not perceive a random element in the process at all. These findings advance understanding of the perceptions of trial participants and raise important issues for those concerned with RCTs. Greater understanding of participants' views provides the potential to improve the management of future trials and so the experience of those agreeing to take part. Key words - randomization, clinical trial participation, attitudes, ECMO

This study aims to assess the lecturers’ opinions about the use of e-learning tools to support distance and blended learning in higher education in Portugal, evidently reinforced by the COVID-19 pandemic. This research was based on a qualitative methodology, specifically, a focus group with professors from five higher education institutions from different geographical areas in Portugal. The obtained results were analysed along four main dimensions: (1) the level of knowledge of e-learning tools, (2) the reasons for using or (3) not using them, and, finally, (4) the opinion of lecturers on the student assessment process using these tools. The results showed that in addition to the concerns with smooth running classes and the appropriate delivery of the syllabus, the lecturers considered the transition to the e-learning context to have been easy. They noted a high level of literacy in the used tools, believed in the continued use of e-learning in the post-pandemic context, indicated several advantages for those involved in the e-learning context and a majority of limitations related to the time required for the adoption of more tools; and, finally, underlined the student assessment issue, which was pointed out as the most sensitive topic in the whole e-learning context. The study informed on the lecturers’ perspective on e-learning and the used tools and provided insight into their perceived usefulness and benefits for lecturers and students. An especially strong concern was verified on the part of lecturers to optimise e-learning tools to provide better knowledge delivery to students.

As a tool, the Sustainable Development Goals (SDG) guide local and regional leaders in developing policy approaches for better social development. SDGs are 17 ambitious objectives towards a greener, healthier, more peaceful and equal planet, promoted by the United Nations to achieve by 2030. Having this performance in mind, countries and regions can measure their level of SDG implementation and rethink how they could promote prosperity, cooperation among regions and progress. This study focuses on SDG-9: Industry, innovation and infrastructure in ten municipalities of the Alto Minho region, Portugal. The main idea is to assess the level of each municipality in the achievement of the indicators related to this SDG. The similarities and differences between the municipalities can underline areas for joint efforts or investments in the development policy. This paper selected a performance analysis as a tool for informing on the amount of effort required to achieve SDG-9 at a local level, i.e., the Alto Minho region in the north of Portugal. If the trend of evolution is maintained, only Viana do Castelo will reach the full range of indicators for SDG-9, and Caminha will have 50 % of the indicators achieved. The remaining municipalities will reach at least half of the indicators, thus achieving a value lower than half of the target value. This approach could be replicated in other SDGs and other regions. This assessment allows the region’s stakeholders to indicate areas of required action to achieve the SDG.

Background: Regional Development (RD) allows countries to balance regional differences by providing economic and social benefits to communities. This research highlights the importance of logistics activities to regional social development, and a framework to assess these connections is proposed.

Background: E-commerce has emerged as a good response to the pandemic of COVID-19. However, the costs of providing a service, which includes a driver and a vehicle, in a regular vehicle that can transport goods that need positive cold (0° to 5°C) are very high.