Self-Care Tips to Keep You Sane: Exploring (the Portland edition)

As I’ve mentioned in previous posts, I’ve been in Portland, Oregon, for work recently. I was there to attend the annual meeting of the Society of Clinical Trials (there are blog posts coming on the talks I attended, workshops I helped to facilitate, and the posters I presented!). The conference ran between Monday 21st May to Wednesday 23rd May, but I chose to fly out the week before on Wednesday 16th. Whenever there is a conference somewhere outside of the UK, I really try to build in time before or after work commitments to explore. I love to travel, and I feel incredibly lucky that my job at the moment allows me to trot around the globe speaking to people, learning, and developing my skills; it’d be a huge shame to fly in and back out without any time to explore.

For me, exploring is one of the best ways for me to decompress and force myself to relax. I figured there are probably lots of people that feel the same – I know that Soph from Soph Talks Science has discussed her passion for travel lots previously, and Lisa from In A Science World has just got back from her post-PhD adventures in Asia. Anyway, I wanted to continue adding to my ‘self-care tips to keep you sane’ series, by giving you an idea of what I got up to in my down time in Portland. Hopefully it’ll encourage my fellow PhD students, academics and people who travel for work to take some time for themselves.

Powell’s book shop

After I landed in Portland on Wednesday, I had dinner and then went to bed. When I woke up on Thursday the first thing on my exploration list was Powell’s book shop. Powell’s is a chain of book shops based across Oregon, but the Portland City of Books store on W Burnside Street is the biggest independent book shop in the world. This is no exaggeration; I spent 8 hours in Powell’s on Thursday. I got lost wandering around each level, even though I had a store map (yes, the store is big enough to have its own map), and I could have very easily spent another 8 hours in there the following day. I knew that whatever I bought in Powell’s needed to be transported the 5,000 miles back to Aberdeen in my suitcase, and that it would be stupid to buy tonnes of heavy books to then have to pay for additional baggage allowances. That said, in those 8 hours I still managed to find and purchase 6 books that I absolutely, definitely could not live without. I know, ridiculous. Even more ridiculous was that I went back on Sunday with a few colleagues and ended up buying 2 more books. I’m sure that I’ll end up reviewing a few of them in blog posts in the future, but mainly I just wanted them for when my thesis is handed in. I love reading, and a visit to Powell’s was my chance to pick up a few books that have not yet been released in the UK yet.

Farm Spirit

If you follow me on Instagram (@heidirgardner if you don’t already!), you’ll already have heard me sing the praises of Farm Spirit. If you’ve seen me in person since last Saturday, you’ll have likely heard the same thing verbally. Now, I’m going to mention it here – my experience at Farm Spirit was so good that I genuinely just want to shout about it so that if anyone is in Portland they can go and visit for themselves.

Farm Spirit is a fine dining restaurant that serves local, seasonal and completely vegan food. The menu is preset, and you need to book tickets in advance – I booked the same week that I booked my flights to Oregon because I was so keen to get a seat. Speaking of seats, at Farm Spirit diners sit communally and dinner is served at set times (usually 6.30pm and 8.30pm). I went for the 8.30pm sitting, and the communal dining thing was perfect for me because I was there alone – colleagues from the UK and Australia weren’t arriving in Portland until the next day. I’m not going to waffle on too much about how good the food was here, I’ll just post a collage of the photographs I took and let you judge for yourself. If you are ever in Portland, you have to visit Farm Spirit; it has been my personal highlight of the trip.

Mother’s Bistro and The Water Front

On Sunday when colleagues had started to arrive in Portland, I was eager to catch up with people I hadn’t seen in ages. Dr Kirsty Loudon (my PhD Supervisors last PhD student) and Karen Bracken (fellow PhD student looking at participant recruitment to trials, but based at the University of Sydney, Australia), headed out for brunch at Mother’s Bistro. After a quick Google the night before, this seemed to be the most highly recommended brunch in Portland. I arrived about an hour before we’d agreed to meet so that I could baggsy a table (they only take limited bookings and the world wants to walk in at around 11am on a Sunday, but it was definitely worth the wait.

After we finished at brunch we went for a wander around the city, headed to the Saturday Market (which is still called the Saturday Market even when it takes place on a Sunday), and then sneaked in another sly visit to Powell’s.. I know, ridiculous. It was super warm on Sunday and my jet lag still hadn’t completely gone (let’s be real, it never really went – I was awake at 4am most days which was not ideal before a full day of conference presentations), so we decided that an early dinner was a good idea. Kirsty and I headed back to the hotel to meet up with another Karen (Innes – a Trial Manager based in Aberdeen), and we had a lovely walk along the waterfront, eventually stopping for dinner at a cute little Italian restaurant that was only 10 minutes walk back to my hotel.

Over the course of the rest of the trip I got the chance to explore more of the culinary delights of Portland, and I managed to resist the urge to head back to Powell’s for a third time.

I really enjoyed my time in Portland, the fact that I had built time in to explore made the late nights/early mornings and few days filled with thesis editing feel much more manageable. The only thing that did shock me though, was the sheer scale of homelessness in Portland. The city clearly has a big problem with homelessness, which I guess isn’t such a shock – every city has homeless people – but this was so much more visible than I had anticipated. I didn’t feel particularly unsafe at any point, but I did feel incredibly guilty that I had flown half way around the world to give a few presentations at significant expense (obviously not personal expense, but still), when there were people sleeping in the streets just metres away from the conference venue.

Breaking Down The Silos – Global Evidence Summit 2017

I’m currently in Cape Town for the Global Evidence Summit; no doubt there will be a few blog posts over the coming days/weeks about what I’m up to over here, what I’m learning, and what it’s like to travel so far from home as part of my PhD. I wanted to write this post whilst it’s fresh in my mind – so it’s a little more research focussed than the exciting travel pictures I hope to bring you soon!

One of the main reasons I wanted to come to the Global Evidence Summit was for one of the themed days. Each of the conference days starts with a plenary, and then there are threaded sessions that allow you to explore a subject in more depth throughout the rest of the day. After a bit of a nightmare with flight delays and missed connections, I missed the first day of the conference. The second day was always going to be my highlight though; day 2 focussed on the ‘Evidence Ecosystem’ and ensuring that we improve the way the entire ecosystem of evidence generation works together, to ensure that evidence can lead to improved patient care.

The plenary session was absolutely brilliant, and certainly did not disappoint.

BREAKING DOWN THE SILOS: Digital and trustworthy evidence ecosystem

This plenary will set out to understand how explicit links between actors are needed – and now possible – to close the loop between new evidence and improved care, through a culture for sharing evidence combined with advances in methods and technology/platforms for digitally structured data.

The session featured talks from Chris Mavergames, Karen Barnes, Greg Ogrinc and Jonathan Sharples, and gave a really brilliant overview of what the evidence ecosystem is, the actors within it, and how it all links together. The cycle below gives you an idea of what I’m talking about (image taken from the MAGIC Project website).

My work, which focusses on improving the efficiency of clinical trials, fits into the ‘Produce evidence’ section at 9 o’clock on the cycle above. As passionate as I am about improving the production of primary research evidence – it is of absolutely no use whatsoever if the rest of the ecosystem doesn’t function properly. So, we need to improve the way we generate primary research evidence, but then ensure that that evidence is synthesised and reviewed effectively and efficiently too. In turn, that information can then be disseminated to clinicians, then to patients, the evidence can be implemented, and then we evaluate it and use it to improve practice. The cycle then begins again.

This plenary session then led to threaded sessions throughout the rest of the day – the first of which I was given the opportunity to co-chair. This was my first experience of co-chairing anything, so I was a bit nervous, but mainly really excited to listen to the speakers’ presentations and then be able to take part in the discussion that followed.

Threaded session 1 of Thursday was titled ‘The inefficiency of isolation: Why evidence providers and evidence synthesisers can break out of their silos’, and focussed on the journey from producing evidence to synthesising evidence.

The 4 talks in this session were:

  1. The problems of poor and siloed primary research – a funder’s view (Matt Westmore).
  2. New ways to access primary research data (Ida Sim).
  3. Data journeys from studies to accelerated evidence synthesis (Anna Noel-Storr).
  4. Connecting primary research and synthesis in education – experiences of operating in a linked system (Jonathan Sharples)

Honestly, these talked linked together really beautifully, and gave me lots to think about in terms of what I can be doing to try and make sure that my research is slotting into the wider evidence ecosystem in a more cohesive way.

Matt gave a funder’s perspective on the problem of disconnected research, and explained what the National Institute for Health Research (NIHR) in the UK are doing to combat these problems. He also gave Trial Forge a shout out too which is always welcome!

Ida’s talk showcased Vivli and explained why it’s so important to share clinical trial meta-data to ensure that we’re not duplicating effort. I’d never heard of Vivli before I’d started doing research into the speakers on the panel, so this was a really interesting session.

Anna gave a fantastic talk on the journey that data takes from studies all the way through to evidence syntheses – the image below shows a slide that she used to explain what evidence sysnthesis is used for, I thought it was a really good way to communicate the concept so I’ve included it here.

Anna is also heavily involved with Cochrane Crowd – a platform that allows volunteers to help to categorise evidence to ensure that evidence syntheses are more efficient. It’s a brilliant platform and one that I’ve contributed to, and with continue to contribute to (probably when I have more time post-PhD though!).

Jonathan then impressed us all with his experience of doing research in the UK education sector. Education is clearly an entirely different beast than healthcare is, but the work that Jonathan and the rest of the team at the Education Endowment Foundation have done really is astounding. I think there’ll be lots of healthcare researchers dissecting the work they’ve done in an effort to try and translate some of their successes into the world of evidence-based healthcare.

I’m not going to go into detail about the rest of the threaded sessions because I’ll be here all day, but as expected they were great. The way that this conference has covered different topics and themes has been so useful, but also totally overwhelming – there is just so much going on! If you’d like to know more about the other threaded sessions, and the Global Evidence Summit as a whole, take a look here.

Evidence Live Day 2 – 22nd June 2017

As I said yesterday, this week I’ve been in Oxford at the Evidence live conference. Thankfully, Oxford cooled down today and I’m much, much less grouchy as a result.Yesterday’s blog post got a really good response and people seemed to appreciate my write up of day 1, so here’s day 2 for you.

Breakfast session – The REWARD alliance and the EQUATOR network: promoting increased value of research

Iain Chalmers and Doug Altman

Weirdly, breakfast sessions at conferences are usually my favourite talks despite the fact I’m very much not a morning person. The people who attend always seem extra passionate, they’re engaged with discussion, and there’s usually croissants which helps too. This session from Iain Chalmers and Doug Altman was predictably, brilliant. I already knew about the REWARD Alliance and the EQUATOR Network before attending, but this fleshed out my thoughts on both of these initiatives. It also demonstrated that even Doug Altman can struggle to get funding sometimes – the EQUATOR Network doesn’t have grant funding currently. The discussion after Iain’s talk was particularly interesting; during his talk he said that ethical committees are actually being unethical in the way that they approve research but do not make up a big proportion of the people making a noise about research waste. An audience comment (from an ethics committee chair) followed and he made a very good point – we as researchers are often going into the conversation with ethics committees with our guards up. We’re ready for a fight before the first punch has been thrown, and it automatically puts the committee on the back foot before you’ve started. Rather than trying to invent ways to circumvent the bureaucracy we so often encounter, we need to work with ethics committees to change the system so that we can improve the quality of research, and try and make the process of doing so more easy for researchers.

Keynote session – Better data, reduced waste in research and public engagement to transform patient care

Chaired by Tessa Richards, presentations from Trish Groves, Simon Denegri and James Munro

Yet another brilliant keynote session; I think this might have been my favourite session of the entire conference.

Tessa Richards started off by talking about patient perspectives, involvement, and how patients are pushing the research agenda where we are dropping the ball. She signposted to some useful resources: www.disruptivewomen.net the #WeAreNotWaiting and #patientsincluded movements, and highlighted the lack of patient voices at Evidence Live this year. Hopefully the organisers will hear Tessa’s call and ensure we have patient representation weaved throughout next year’s programme. Trish Groves took to the floor and discussed how we can increase value in health research and make it truly able to improve patient care. The answer? Patient involvement. She highlighted the role of patient reviewers within the BMJ’s publication and review process too which I thought was brilliant.

Next up, Simon Denegri. He started his talk with a series of emojis so that was me immediately on board.. Anyway, yet another fantastic talk that focussed on patients, patient involvement, and the funding gap between research planning and research conduct. We shouldn’t be involving patients throughout every stage of our research work; it can be a waste of their time. To get the most value out of patient insight, and the most efficient use of patient time, we need to work with patients to see where they want to be involved and where they feel they can make the most difference to the research project. Simon also had a great analogy for the tokenistic patient involvement we so often see – a Ford Escort is still a Ford Escort no matter if you add a spoiler, tint the windows and lower the suspension; for you to maintain any street-cred at all, you really just need to re-build.

The session finished with a talk from James Munro from Care Opinion; a website that allows patients to give anonymous feedback about the health services they interact with across the UK. Uniquely, this platform is also linked up with healthcare professionals, this means that concerns, complaints etc can be resolved efficiently. James gave a few examples throughout his talk, one of the most simple being a patient that could not hear when the nurse called her name in the clinic – the seats were faced towards the wall and the patient was deaf in one ear, meaning she couldn’t figure out where the noise was coming from. In just 2 days contact had been made with the clinic involved, and a plan made to turn the seats around to ensure patients don’t run into this problem again. This service isn’t focussed on clinical problems, it really gives patients a voice about any aspect of their interactions with the health services; something as simple as turning the chairs to face a different direction could make the process of visiting a GP so much more comfortable. James also highlighted the need to keep an eye on the ‘small data’ in a world where big data seems to be promising us so much. Big data certainly has the potential to be great, but small data gives meaning. My personal favourite patient quote that James referenced in this talk? ‘Thank you for fixing my brain, it’s chuffing great.’

Parallel session – Clinical trials

Chaired by Jeffrey Aronson, presentations from Amy Rogers, Penny Reynolds, Heidi Gardner (yep, me!), Patrick van Rheenen and Ignacio Atal

A really interesting session that covered a broad range of topics related to clinical trials. Highlights from Amy Rogers from the University of Dundee who gave a brilliant talk, ‘Large streamlined trials – what works, and what doesn’t’. Her talk gave a brilliant overview of the challenges that pragmatic trials can bring, but also the ways that trials units manage to overcome these hurdles in order to conduct brilliant trials. Penny Reynolds’ talk was also brilliant, ‘Why academic clinical trials fail: trial ‘cemetery demographics’ and a case study’. The trials graveyard is something I seem to know quite well given that my research focusses on recruitment – trials are often abandoned due to poor recruitment. Penny’s study drew attention to the management problems that trials faced, and she hypothesised that poor recruitment is a symptom of the underlying disease of bad management.

After these two talks I then presented work on behalf of the HSRU Public Engagement With Research Group – mentioned in this blog post. I talked about our event, ‘Explorachoc’; a chocolate trial that aimed to demonstrate randomisation to the public. I took along the coloured balls we used in Explorachoc, and sweets in yellow and blue bags, and did a live demo of our event. Jeff Aronson who was chairing the session seemed to enjoy being randomised to the blue arm of the trial, which earned him a marshmallow (I did take chocolates with me but they suffered a tragic melting accident between London and Oxford on Tuesday evening, so marshmallows and jelly babies it was!).

A few pictures of my presentation taken by members of the audience:

Picture taken from the The Centre for Evidence-based Veterinary Medicine Twitter page.

Picture taken from the BMC Medical Evidence Twitter page.

Unfortunately I had to leave after this session to catch a bus to Heathrow Airport to make sure I made my flight. British Airways had other ideas though; I’m currently typing this from the Holiday Inn Express at Heathrow because my flight was cancelled due to bad weather. Hopefully I’ll finally make it back to Aberdeen tomorrow morning! I wish I’d known that my flight was cancelled earlier because the final talks looked brilliant, I did manage to keep up to date via Twitter which was great – take a look at #EvidenceLive if you want to find out more!

So that’s it, Evidence Live is over for another year! A brilliant programme filled with inspiring and thought-provoking talks, enthusiastic speakers and a beautiful setting too. This time next year I’ll be nearing thesis submission, so I may have to skip Evidence Live 2018; I’m keeping my fingers crossed that I can make the timings work because it’s one of the most down to Earth, friendly and determined atmospheres I’ve experienced at a conference.

The one thing I wish Evidence Live had this year? A doodler (I don’t think that’s the technical term). Last year Stefania Marcoli was at the conference each day, and she did live summaries including snippets of talks and quotes from attendees. This year we didn’t have anyone doing this, and I think the conference really missed it.

Here’s last year’s summary from day 1:

Credit: Stefania Marcoli

Evidence Live Day 1 – 21st June 2017

This week I’ve been in Oxford at the Evidence live conference – side note: Oxford is currently hotter than the surface of the sun and I genuinely miss Autumn and Winter. As I’m at Evidence Live I thought if would be cool to blog each day; there’s lots of people I have spoken to that wanted to attend but couldn’t, so here’s a run down for those that missed day 1.

Introduction

Carl Heneghan

As expected, Carl started Evidence Live in a really enthusiastic way. He introduced the Evidence-Based Medicine (EBM) manifesto (more on that later), revealed his new post as Editor-in-Chief of the BMJ’s EBM Journal, and told us how we are currently relying on readers to have ‘a good nose’ when it comes to evidence. Yes, in the 21st century, ‘a good nose’ is apparently a real thing we’re using to distinguish decent research from crap research. Carl highlighted that lots of the things that can have an impact on research are types of biases; when paired with the fact that effects of new interventions are often very small, and we’re left with an evidence-base that’s incredibly vulnerable.

Here Carl talk more here in this short clip recorded after his welcome address.

Workshop – Routinely collected health data (RCD) for randomised controlled trials (RCTs)

Lars Hemkens, Kimberly McCord and Heidi Gardner (yes, me!)

I can’t really give you an unbiased report of this workshop since I was one of the speakers, so I’ll try to remain objective. We uncovered the links between trialists and coffee (the stress of doing trials); why clinical research often fails; what RCD could do for RCTs and why we shouldn’t be thinking of the two concepts as opposites; and also gave a few examples of trials where RCD has been used successfully. Lots of brilliant discussion, and a feeling that we need the infrastructure and IT systems to catch up with our thought process; some cases where a trial team has had to wait over a year for data to be released from NHS Digital, and that’s when the trial’s been up and running for a while beforehand. I really enjoyed this session because the audience were so engaged, ideas exchanged and barriers/solutions brain-stormed. Looking forward to working further with Lars and Kim on this over the next few months; we’ve got a paper almost ready to submit so fingers crossed we’ll have that published before my PhD is over too.

Keynote session – Transparency of trial data, improvement in safety and better quality research to improve healthcare

Chaired by Kamal Mahtani, presentations from Fergal O’Regan, Mary Dixon-Woods and Doug Altman

SUCH A GOOD SET OF KEYNOTE LECTURES. If I can present half as well as these guys one day I’ll be so chuffed with myself. Anyway, fangirl moment over – this session looked at transparency of clinical trial data and pharmacovigilance data from the perspective of the European Medicines Agency (EMA); how we can improve the evidence for improving healthcare, and we finished off with a cracker of a talk from Doug Altman on the scandal of poor medical research. This was my highlight of day 1. Doug published a paper titled ‘The scandal of poor medical research‘ in the BMJ in 1994, and this talk was a reflection on what’s changed in the 23 years since. Sadly, not much. Doug strengthened his message, “let’s start calling it bad research, it’s not just poor, it’s plain bad“, and also gave some brilliant words of wisdom on when to do research, “Ignorance of research methods is no excuse; if you can’t do it well, don’t do it.

Here Mary talk more here in this short clip recorded after her talk.

Workshop – How to write papers that add value in health research and deserve publication

Trish Groves

A brilliant session for early-career researchers and students – and one I found really valuable. Trish gave a few tips on resources that will help budding resources (e.g. checklists as found on the EQUATOR Network website), revealed the acceptance rate for submissions to the BMJ (~4%), and encouraged us to never give up when it comes to publishing; if the science is solid, it will get published somewhere. She also drew attention to the research methods we use, which I thought was a brilliant topic to highlight in this talk. Many people think journals publish based on ‘positive’ results, but the good ones don’t; they’re looking for new, interesting and relevant research questions with solid methodology. After that it doesn’t really matter what the results show. In Trish’s own words, “Methods are the most important part of any paper, without them the rest won’t make sense.

A final word of advice from Trish; keep the writing simple. For the slide below ‘the cow jumped over the moon’ would have worked better.. (slide taken from the Students 4 Best Evidence Twitter page)

Here Trish talk more here in this short clip recorded after her workshop.

Parallel session – Evidence synthesis

Chaired by Jeffrey Aronson, presentations from Tone Westergren, Sietse Wieringa, Carme Carrion, Lyubov Lytvyn, Izhar Hasan and Karolina Wartolowska

A really interesting session that covered lots of different aspects of evidence synthesis. Highlights from Sietse Wieringa who gave a thought-provoking talk titled ‘Has evidence based medicine ever been modern? A Latour inspired understanding of the changing EBM’; Lyubov Lytvyn who gave an overview of the RapidRecs we see in the BMJ with a talk titled, ‘Innovative patient partnership in creating trustworthy guidelines, from protocol to publication: Case studies of BMJ Rapid Recommendations’; and Karoline Wartolowska who discussed the placebo effect and how it changes over time in ‘Temporal characteristics of effect size in the placebo arm of surgical randomised controlled trials – a meta-analysis.’

Open session – Carrots, sticks, or stones? Audit and accountability to improve research quality

Ben Goldacre

Before I came to Oxford I was describing Evidence Live to a friend, I mentioned the usual faces and topics I expected would be discussed, and my friend did not focus on anything academic, none of the topics I’d mentioned; she just said, “Ben Goldacre is kind of a big deal.” I guess she was right, and this talk demonstrated just how many projects/initiatives he is involved in that are working to improve research quality. He talked at length about the need for ‘sustained pressure’ when it comes to getting reporting standards up – this isn’t something that will change over night, but the TrialsTracker will hopefully help.

He specifically asked that sections of the talk weren’t tweeted, and I nodded along when he asked for agreement – so that’s all I’m giving you.

Open session – Better evidence for better healthcare: Consultation

Ben Goldacre and Carl Heneghan

If you haven’t seen or heard of the EBM Manifesto then take a look here. Essentially this aims to kick us into action; we know that evidence generation is not at the standard it should be, patients are being let down as a result, and this manifesto aims to get a sort of action plan together of what we can do to improve things. The infographic below gives a summary of the 9 steps of the EMB Manifesto – which will hopefully lead to us changing the landscape of EBM for the better. I’ll just say that this session started at 6pm and the audience were getting restless at this point; there was the promise of a cold beer and 33 degree heat on the other side, so we made this session quick. That said, the way this was done was brilliant; super efficient and cut out the waffle that usually comes with a consultation of any kind.

One of the things I love about Evidence Live is how solutions-driven it is – speakers openly say that we no longer need to see hundreds of papers published telling us what the problems are with clinical research, we need to get to work and fix them. The aim of this session was exactly that. We were given the task of creating the jobs lists of different stakeholder groups (funders, journal editors, researchers, patient groups etc). We submitted our ideas for jobs along with the problem it’s trying to fix, and how we could measure its success if implemented. Simple as that!

There’s an online version of the form we completed at the consultation here – it’s still open to submissions so please do contribute if you wish.

Overall, an absolutely brilliant first day at Evidence Live; I’m really looking forward to tomorrow’s discussions – check back tomorrow for a blog post covering day 2!

4th International Clinical Trials Methodology Conference and 38th Annual Meeting of the Society for Clinical Trials – Liverpool, May 2017

This week I left the grey skies of Aberdeen in favour of… Liverpool. Nowhere hugely exotic, but the weather was absolutely beautiful for the 3 days I was there.
Anyway, more about why I was there. Sunday to Wednesday saw almost 1,000 delegates congregate in Liverpool for the joint 4th International Clinical Trials Methodology Conference (ICTMC) and 38th Annual Meeting of the Society for Clinical Trials (SCT). 2 and a half days of people interested in trials, tackling subjects like: data-sharing, registry-based trials, recruitment and retention, patient and public involvement with research, qualitative research, funding, publishing, and a tonne of other subjects besides.

I’ve been to one ICTMC before, in Glasgow in 2015, but this was a much bigger version because it was joint with the American SCT annual meeting. The days were jam packed and I came home with a notebook full of ideas. Really I think it’ll take a few weeks for me to process everything properly and start to formulate my own ideas for future research based on the priorities demonstrated at the conference.

Anyway, just a short blog post from me this week – with 3 days out of the office I’m a bit behind on my to do list! As with the SWAT workshop that we had in Aberdeen in March, I’ve consolidated the majority of my notes into a sort of mind map/cartoony page of doodles. I find that this really helps me to get to grips with what’s been talked about, and ensures that I don’t leave all my notes held captive in a notebook at the back of my desk drawers.

I shared these on Twitter earlier in the week and got a really positive response, so I thought I’d upload them here too.