Introducing the Fear Learning and Anxiety Response (FLARe) app and web portal for the remote delivery of fear conditioning experiments

Experimental paradigms measuring key psychological constructs can enhance our understanding of mechanisms underlying human psychological well-being and mental health. Delivering such paradigms remotely affords opportunities to reach larger, more representative samples than is typically possible with in-person research. The efficiency gained from remote delivery makes it easier to test replication of previously established effects in well-powered samples. There are several challenges to the successful development and delivery of remote experimental paradigms, including use of an appropriate delivery platform, identifying feasible outcome measures, and metrics of participant compliance. In this paper, we present FLARe (Fear Learning and Anxiety Response), open-source software in the form of a smartphone app and web portal for the creation and delivery of remote fear conditioning experiments. We describe the particular benefits and challenges associated with the creation of a remote delivery platform for fear conditioning, before presenting in detail the resultant software suite, and one particular instance of deploying this using the FLARe research infrastructure. We provide examples of the application of FLARe to a number of research questions which illustrate the particular benefits of the remote approach to experiment delivery. The FLARe smartphone app and web portal are available for use by other researchers and have been designed to be user friendly and intuitive. We hope that FLARe will be a useful tool for those interested in conducting well-powered fear conditioning studies to inform our understanding of the development and treatment of anxiety disorders.

Report of the Skin Research Working Groups From the GRAPPA 2020 Annual Meeting

At the 2020 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), the International Dermatology Outcome Measures (IDEOM) Initiative Psoriasis (PsO) Working Group presented an update on its work to agree on meaningful, valid, and feasible outcome measures for PsO randomized controlled trials and longitudinal observational studies. The Treatment Satisfaction Working Group presented the development of a treatment satisfaction instrument to be utilized in PsO clinical trials. The Musculoskeletal Symptoms Working Group presented an overview of their work conducted to date to define how to best measure musculoskeletal symptoms in PsO clinical studies, and discussed next steps during an open-panel discussion, which included PsO and psoriatic arthritis experts.

Former prisoners between non-category and invisibility: The Romanian experience

In this study, we examine the re-entry of 58 people during the first year following their release from prison. Our objective was to gain a more comprehensive perspective on the experience of release from a Romanian prison. We take into account three important dimensions that set the tone and tenor of life after prison: (1) the state as a truant agent in the process of release, (2) family, and (3) employment and other means of becoming economically active, such as hustling (Thieme, 2018) or foraging (Sugie, 2018). We argue that the existent re-entry legislation (or lack thereof) coupled with the way policymakers define the notion of personhood for the former inmate embarks prisoners on a journey widely disconnected from their relevant social contexts. As a consequence, the challenges associated with re-entry are disregarded, and prisoners, once released, become invisible or a ‘non-category’. Successful re-entry, we argue, is a personal accomplishment in the face of adversities, rather than a feasible outcome afforded by structural conditions.

International experience with performance-based risk-sharing arrangements: implications for the Chinese innovative pharmaceutical market

ObjectivesVarious forms of outcomes-based or risk-sharing agreements have been implemented since early 2000s as a way of access to innovative medicinal products. This study aims to summarize the international experience of performance-based risk-sharing arrangements (PBRSAs) and identify the preconditions for a successful implementation of such schemes. Their implications for the Chinese healthcare market are discussed.MethodsA systematic literature review (in PubMed) was conducted to review the evidence on the nature and performance of PBRSAs in the past 10 years. Grey literature was searched for reports in government websites of the countries in scope.ResultsThe search identifies 463 records from PubMed and 3 additional records from other sources. Thirty-one publications are included in the final review. The following preconditions were identified to support a successful implementation of PBRSAs: (1) Identify meaningful and feasible outcome measurements; (2) Establish an effective and efficient data collection infrastructure; (3) Control of the implementation costs; (4) Develop governance and administrative infrastructure to allow delisting and rebate/refund; (5) Clarify personal data protection issues.ConclusionsThe implementation of PBRSAs has proven to be challenging. Although the Chinese healthcare system is not yet well equipped to implement such schemes, some recent changes may pave the way to successful PBRSAs for particular innovative products.

Effective accreditation in postgraduate medical education: from process to outcomes and back

Background The accreditation of medical educational programs is thought to be important in supporting program improvement, ensuring the quality of the education, and promoting diversity, equity, and population health. It has long been recognized that accreditation systems will need to shift their focus from processes to outcomes, particularly those related to the end goals of medical education: the creation of broadly competent, confident professionals and the improvement of health for individuals and populations. An international group of experts in accreditation convened in 2013 to discuss this shift. Main text Participants unequivocally supported the inclusion of more outcomes-based criteria in medical education accreditation, specifically those related to the societal accountability of the institutions in which the education occurs. Meaningful and feasible outcome metrics, however, are hard to identify. They are regionally variable, often temporally remote from the educational program, difficult to measure, and susceptible to confounding factors. The group identified the importance of health outcomes of the clinical milieu in which education takes place in influencing outcomes of its graduates. The ability to link clinical data with individual practice over time is becoming feasible with large repositories of assessment data linked to patient outcomes. This was seen as a key opportunity to provide more continuous oversight and monitoring of program impact. The discussants identified several risks that might arise should outcomes measures completely replace process issues. Some outcomes can be measured only by proxy process elements, and some learner experience issues may best be measured by such process elements: in brief, the “how” still matters. Conclusions Accrediting bodies are beginning to view the use of practice outcome measures as an important step toward better continuous educational quality improvement. The use of outcomes will present challenges in data collection, aggregation, and interpretation. Large datasets that capture clinical outcomes, experience of care, and health system performance may enable the assessment of multiple dimensions of program quality, assure the public that the social contract is being upheld, and allow identification of exemplary programs such that all may improve. There remains a need to retain some focus on process, particularly those related to the learner experience.

Community mobility plans for individuals with developmental disabilities: A feasibility study

Introduction Individuals with intellectual and/or developmental disabilities have unmet transportation needs, which limits their community mobility. Access to transportation is linked to community participation and independence in adult outcomes. The purpose of this study is to examine the implementation feasibility of individualized community mobility plans. Methods A pre-test post-test one group design was used to determine if methodology and implementation procedures were feasible. Outcome measures were evaluated to determine if appropriate for future effectiveness research. Participants were six adults with intellectual and/or developmental disabilities who received the community mobility plans intervention over a period of 3–8 sessions. Community mobility plans use a cyclical process where the individual first develops self-determined community mobility goals, followed by a comprehensive assessment process, and individualized environmental and person-centered travel interventions. Results Participants demonstrated significant improvement between pre- and post-test scores on the measures of the Progressive Evaluation of Travel Skills ( t(5) = –4.481, p = .007) and Goal Attainment Scaling ( t(5) = –7.457, p =.001). Conclusion Community mobility plans may provide a feasible option to improve community mobility for individuals with intellectual and/or developmental disabilities, although further research is needed to determine effectiveness.