69832 research outputs found
Sort by
Perceptions and experiences of healthcare professionals of implementing the Organ Donation (Deemed Consent) Act in England during the Covid-19 pandemic.
Get PDFCONTEXT: In May 2020 during the COVID-19 pandemic, England implemented a 'soft' opt-out system of consent to deceased organ donation. As part of a wider evaluation, this analysis focused on the perceptions of health care professionals, specifically their experiences of implementation.
METHODS: Mixed-methods study informed by Normalisation Process Theory, based on two national surveys of health care professionals and interviews, observations and document analysis, across two case study sites. Routine NHS Blood and Transplant's audit data provided context.
FINDINGS: 70 interviews with 59 staff and 244 first and 738 second surveys. COVID-19 affected every aspect of implementation. Although supportive in principle, many staff were unconvinced that legislative changes alone would increase consent rates. Many staff were redeployed or left their jobs. As a result, staff were not able to work collectively as intended for implementation. Staff received routine donor audit data suggesting the law was yet to make a difference to consent rates, reducing their enthusiasm and commitment.
CONCLUSIONS: Implementation could have been more impactful if delayed. The National Health Service needs to reprioritise organ donation and relaunch the implementation plan in the post-pandemic period, though it is unlikely the changes will bring about a significant increase in consent rates
Making Light Work: Infrastructures and Their Many Publics
Get PDFThis article explores the multiplicity of publics that are enacted in relation to infrastructures. We take the case of street lighting infrastructure in the UK in 2013/4, at a point when innovations in light emitting diode (LED) and smart technologies were making the infrastructuring of street lighting newly visible. Multifarious, emergent and recursive publics were variously enacted by lighting professionals, researchers, and publics themselves as part of this infrastructuring. We argue that these publics were constituted vis-à-vis other actors and entities and coalesced around configurations and attributions of knowledge, uncertainty and ignorance. “Supra-publics” indexed long-standing local knowledge gained by lighting professionals. “Occasioned publics” vis-à-vis technocratic expertise emerged when infrastructures became newly visible as lighting professionals (or researchers) consulted publics. “Citizen publics”, mobilized vis-à-vis governance, carefully marshalled experiential knowledge alongside newly acquired technical knowledge. These categories are neither comprehensive nor mutually exclusive, and their contours have shifted since our fieldwork as domains of knowledge and ignorance have changed. However, they are indicative of the multiplicity of publics that are part of lighting infrastructure in liberal states, and suggestive of ways in which publics are not stable entities, but rather in constant flux, as infrastructuring makes light work
Interactive voice response surveys as a method for increasing the representativeness of rural respondents in a mortality mobile phone survey: Findings from Malawi.
Get PDFOBJECTIVES: Our study aims to (i) evaluate the yield and costs of a fully automated interactive voice response survey as a screening tool for identifying rural respondents for participation in a mortality mobile phone survey, and (ii) compare mortality survey call outcomes among interactive voice response pre-screened and unscreened numbers. METHODS: In order to identify respondents living in rural areas, a short interactive voice response survey was conducted among 24,924 unique mobile phone numbers to determine place of residence (Rural vs. Other). We calculated the proportion of rural numbers derived from the interactive voice response survey among all numbers dialled. Mobile phone numbers screened with interactive voice response were then combined with those generated via random digit dialling and used in a national mortality mobile phone survey in Malawi. Final dispositions for each mobile number dialled were compared for both groups by testing the difference in proportions. RESULTS: Approximately half of all phone numbers dialled in the interactive voice response survey were answered, and among them, 33.9% indicated that they lived in a rural area. The cost per completed interactive voice response was US17.4 per completed mortality survey. In comparison, less than a quarter of the numbers that were not screened through interactive voice response resulted in a completed mortality survey (45.3% vs. 22.3%, p <0.001). On average, 12 call attempts were required to complete a mortality survey interview in the unscreened group, compared to 6.3 call attempts among the interactive voice response pre-screened numbers. CONCLUSIONS: Interactive voice response surveys can be used to increase the representation of rural respondents in mobile phone surveys at an acceptable cost. Modifications to the interactive voice response survey process (e.g., survey timing and number of call attempts) should be explored further to increase engagement
Associations between accelerated forgetting, amyloid deposition and brain atrophy in older adults.
Get PDFAccelerated long-term forgetting (ALF) is the phenomenon whereby material is retained normally over short intervals (e.g. minutes) but forgotten abnormally rapidly over longer periods (days or weeks). ALF might be an early marker of cognitive decline, but little is known about its relationships with preclinical Alzheimer's disease pathology and how memory selectivity might influence which material is forgotten. We assessed ALF in 'Insight 46', a sub-study of the MRC National Survey of Health and Development (a population-based cohort born during the same week in 1946) (n = 429; 47% female; assessed at age ∼73 years). ALF assessment comprised visual and verbal memory tests: complex figure drawing and the face-name associative memory exam (FNAME). ALF scores were calculated as the percentage of material retained after 7 days, relative to 30 min. In 306 cognitively normal participants, we investigated effects on ALF of β-amyloid pathology (quantified using 18F-Florbetapir-PET, classified as positive/negative) and whole-brain and hippocampal atrophy rate (quantified from serial T1-MRI over ∼2.4 years preceding the ALF assessment), in addition to interactions between these pathologies. We categorized complex figure drawing items as 'outline' or 'detail', to test our hypothesis that forgetting the outline of the structure would be more sensitive to the effect of brain pathologies. We also investigated associations between ALF and subjective cognitive decline, measured with the MyCog questionnaire. Complex figure 'outline' items were better retained than 'detail' items (mean retention over 7 days = 94% versus 72%). Amyloid-positive participants showed greater forgetting of the complex figure outline compared with amyloid-negative participants (90% versus 95%; P < 0.01). There were interactions between amyloid pathology and cerebral atrophy, such that whole-brain and hippocampal atrophy predicted greater ALF on complex figure drawing among amyloid-positive participants only [e.g. 1.9 percentage-points lower retention per ml/year of whole-brain atrophy (95% confidence intervals 0.5, 3.7); P < 0.05]. Greater ALF on FNAME was associated with increased rate of hippocampal atrophy. ALF on complex figure drawing was also correlated with subjective cognitive decline [-0.45 percentage-points per MyCog point (-0.85, -0.05); P < 0.05]. These results provide evidence of associations between some measures of ALF and biomarkers of brain pathologies and subjective cognitive decline in cognitively normal older adults. On complex figure drawing, 'outline' items were better remembered than 'detail' items, illustrating the strategic role of memory selectivity, but 'outline' items were also relatively more vulnerable to ALF in individuals with amyloid pathology. Overall, our findings suggest that ALF might be a sensitive marker of cognitive changes in preclinical Alzheimer's disease
Afghanistan-Pakistan retinoblastoma "Silk Road" referral pathway.
Get PDFBACKGROUND/OBJECTIVES: There is no specialist retinoblastoma (Rb) treatment centre in Afghanistan. We aimed to describe the first-year experience and outcome of referring Afghani children with Rb to Pakistan for treatment via the Afghanistan-Pakistan Rb "Silk-Road" referral pathway. METHODS: A 12-month prospective analysis (January 2023-January 2024) was conducted on children with suspected Rb presenting at National Organisation for Ophthalmic Rehabilitation (NOOR) eye care centres. Online consultations with specialists from the Rb-NET were used to confirm Rb diagnoses, and eligible patients were identified for referral to Rb treatment centres in Pakistan. Data on clinical presentation and outcomes were recorded using a structured Microsoft Excel spreadsheet, which was monitored by the entire team to ensure accuracy and completeness. The primary outcomes included successful transfer to Rb treatment centres in Pakistan and child survival at 1-year follow-up. Secondary outcomes focused on identifying barriers to successful patient transfer. RESULTS: Of the 23 children included in the study, 12/23 (52%) were referred due to leukocoria, 11/23 (48%) were female, 7/23 (30%) presented with bilateral Rb, and none had familial Rb. Overall, 5/23 (22%) children were diagnosed with extraocular disease, and 6/23 (26%) had distant metastases at the time of diagnosis. Only 9/23 (39%) children successfully reached Rb treatment centres in Pakistan. At the last follow-up, 5/23 (22%) children had died, 6/23 (26%) were confirmed alive, and 12/23 (52%) were lost to follow-up. The most common obstacles to patient transfer included difficulty crossing the Afghani/Pakistani border (12/23; 52%) and economic barriers (11/23; 48%) throughout the referral process. CONCLUSIONS: This report highlights the immense difficulties in improving child survival from a treatable childhood cancer in a country with poor health care systems. The first-year experience of this referral pathway offers valuable lessons, which can guide the creation of a dedicated Rb treatment centre within Afghanistan
Intestinal mucosal immune responses induced by novel oral poliovirus vaccine type 2 and Sabin monovalent oral poliovirus vaccine type 2: an analysis of data from four clinical trials.
Get PDFBACKGROUND: A novel oral polio vaccine type 2 (nOPV2), which is more genetically stable (ie, lower risks of reverting to neurovirulence) than the Sabin monovalent OPV2 (mOPV2), has been deployed to interrupt circulating vaccine-derived poliovirus type 2 (PV2) outbreaks. This study compares intestinal mucosal immune responses induced by nOPV2 and mOPV2. METHODS: In this analysis, we evaluated intestinal mucosal immune responses in healthy participants of different ages (ie, infants aged 18-22 weeks, children aged 1-4 years, and adults aged 18-50 years) and vaccine backgrounds (ie, OPV2-experienced vs OPV2-naive). Participants were selected from two phase 2 trials of nOPV2, conducted in 2018-19 (infants and children, NCT03554798 [Panama]; adults, EudraCT 2018-001684-22-NCT04544787 [Belgium]), and two phase 4 historical control trials of mOPV2, conducted in 2015-16 (infants and children, NCT02521974 [Panama]; adults, EudraCT 2015-003325-33 [Belgium]). We measured PV2-specific neutralising activity and IgA concentrations in stools collected before and 14 days after vaccination. FINDINGS: We compared data from 160 participants (ie, 47 infants, 47 children, and 66 adults) in the nOPV2 trials to 188 participants (ie, 42 infants, 46 children, and 100 adults) in the mOPV2 trials. Within each age group, one dose of nOPV2 or mOPV2 induced similar intestinal PV2-specific neutralisation and IgA responses on day 14. Responses diminished with age: among the OPV2-naive participants who received nOPV2, 27 (82%) of 33 infants, 17 (61%) of 28 children, and four (25%) of 16 adults had detectable PV2-specific neutralisation on day 14. Despite having similar median log10 IgA responses (1·4 [IQR 1·0-2·2] vs 1·4 [1·1-1·7], p=0·34) and median log2 neutralisation titres (1 [IQR 1-1] vs 1 [1-1·5], p=0·89) on day 14, a smaller percentage of OPV2-experienced adults shed vaccine virus than OPV2-naive adults upon nOPV2 challenge (20% vs 82%, p<0·0001). INTERPRETATION: We found no evidence of differences in the intestinal mucosal immune responses induced by nOPV2 or Sabin mOPV2 and observed the strongest responses in infants. FUNDING: The Bill & Melinda Gates Foundation, Japan Agency for Medical Research and Development
Future changes in rainy seasons in the Upper Blue Nile Basin: Impacts on agriculture and water resources
No full textChanging climate is increasingly influencing the rainy seasons and posing significant challenges for agriculture and water resource management in vulnerable regions. The study examines the spatiotemporal variation of rainy seasons in the Upper Blue Nile Basin (UBNB) of Northwestern Ethiopia using projections from the CMIP6 climate models to assess potential impacts on agricultural and water planning. We analyzed observed and projected precipitation data across three Shared Socioeconomic Pathway (SSP) scenarios: SSP1-2.6, SSP2-4.5, and SSP5-8.5, spanning near-term (2015–2044), mid-term (2045–2074), and long-term (2075–2100) periods. To correct systematic biases in model outputs, a power transformation technique was applied to precipitation data from seven CMIP6 models. The finding of the study showed that the INM-CM5-0 model is the most accurate in simulating precipitation patterns, forming the basis for our detailed analysis. Our findings reveal significant shifts in the timing and duration of rainy seasons across all scenarios, with more pronounced changes under the highest emission pathways, SSP5-8.5. The SSP5-8.5 scenario indicates the most substantial extension in the length of rainy season, particularly in lowland areas, due to both earlier onset and delayed cessation. Conversely, highland and midland regions are projected to experience shorter rainy seasons, lasting between 82 and 130 days, driven by delayed onset and earlier cessation. These shifts could profoundly affect agricultural productivity, necessitating adjustments in planting and harvesting schedules by several months. Under high-emission scenarios, crop cycles may become misaligned with traditional planting windows, especially in highland areas where shorter rainy seasons may constrain crop viability. This study highlights the urgent need for adaptive strategies, such as the practice of early-maturing crop varieties, to enhance resilience to the change of projected seasonal rainfall patterns. Proactive measures, particularly in highland communities, are crucial for maintaining food security and effective water resource management to enhance adaptation options to climate change impacts in the area. These insights can guide targeted agricultural policies and resource planning, helping to mitigate the adverse impacts of climate change on food and water security
Performance characteristics and potential public health impact of improved pre-erythrocytic malaria vaccines targeting childhood burden.
Get PDFNew malaria vaccine development builds on groundbreaking recommendations and roll-out of two approved pre-erythrocytic vaccines (PEVs); RTS,S/AS01 and R21/Matrix-M. Whilst these vaccines are effective in reducing childhood malaria within yearly routine immunization programs or seasonal vaccination, there is little evidence on how different PEV efficacies, durations of protection, and spacing between doses influence the potential to avert uncomplicated and severe childhood malaria. Mainly, lacking understanding of the required vaccine properties and delivery strategies that lead to an effective childhood vaccine with multi-year protection. We used an individual-based model of malaria transmission informed by trial data to quantify trade-offs between PEV performance properties and impact across different endemicities, deployment schedules, and coverage levels. We found that deploying a vaccine with 90% initial efficacy against infection, with a six to 12-month half-life duration of protection, co-administered with a blood-stage drug, followed by yearly boosters, results in 60-80% yearly incidence reduction, consistent with seasonal RTS,S and R21 trials. Halting vaccination after five years, leads to sustained protection of at least a 35% incidence reduction in children less than six years in the 12 months following cessation in settings where PfPR2-10 90%) and longer half-life duration (>12 months) are required to sustain impact beyond primary vaccination, averting up to half the preceding year's burden. The contribution of each property to the overall impact varies by setting and clinical endpoint, indicating that public health goals should dictate key vaccine performance criteria. Overall, our findings support the need for well-defined target product profiles for long duration vaccines linking priority use cases of where, how, and to whom to deploy new malaria vaccines, to maximize public health impact
Community perspectives on drug promotion on social media during the COVID-19 pandemic in KwaZulu-Natal, South Africa [version 1; peer review: 2 approved with reservations]
Get PDFBackground: During the COVID-19 pandemic, social media and web-based platforms were widely used to promote medicinal substances. To assess community perspectives on drug promotions on social media, we conducted qualitative research using three workshops. The workshops aimed to highlight the public understanding of drug advertising focusing on community perceptions of social media drug promotions, their risks and benefits. Discussions were conducted on the importance of adhering to national drug regulation policies and the World Health Organisation ethical criteria for promotion, advertisement, and publicity of medicines.
Methods: Participants for the workshops were purposively sampled from local community youth groups and healthcare facilities. Two workshops included ten young adults aged 18-35, while the third workshop involved three healthcare professionals and one traditional healer.
Results: The study participants’ highlighted the value of honesty and trust in the drug promotions. Gaps in the ethical conduct of advertising were observed and concerns were raised about the reliability of social media information and the omission of valuable details on the drug advertisements.
Conclusion: Individuals have a right to informed choices that ensure their health safety. This study has highlighted the need for transparency and accountability in pharmaceutical and complementary medicine marketing on social media. Collaboration is needed between regulatory bodies, pharmaceutical companies, healthcare providers and community members, to make sure that drug advertising upholds ethical standards and public health
Headteacher challenges and opportunities of implementing COVID-19 preventive measures in schools in England from 2022 onwards
Get PDFObjective:
Government guidance to reduce COVID-19 transmission was rapidly implemented by headteachers in primary and secondary schools in England. This study investigated the main challenges and opportunities faced by headteachers during the pandemic recovery period (starting in March 2021 when schools reopened indefinitely). Findings are intended to inform education policy to support schools and for future outbreaks.
Design:
Qualitative study involving semi-structured interviews.
Setting:
Primary and secondary schools in England from April to September 2022.
Method:
We undertook remote interviews using Zoom with 10 headteachers and senior leaders from six primary and four secondary schools. A thematic analysis was conducted to identify challenges and opportunities faced by schools when implementing COVID-19 preventive measures.
Results:
Participants continued to implement some preventive measures (ventilation, optional face masks, handwashing) into the recovery period. Hybrid learning was a large burden on schools, even more so than remote learning. Many schools felt confident in their ability to scale preventive measures up or down if needed in the future. Due to the increased utilisation of resources dedicated to the COVID-19 response, school budgets were felt to be at risk for the forthcoming school years.
Conclusion:
Implementation measures advised by the Government were perceived as helpful but came at a large human resource and financial cost. Schools should be provided with flexible guidance to allow leadership to tailor preventive measures to their own context. This would require technical advisory support to be available. Further research is needed to understand the impact of the COVID-19 recovery period on a wider scale for both teachers and students