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“Attending to Collaboration” in Major System Change in Healthcare in England: A Response; Comment on “Attending to History” in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration
Get PDFIn this short article we comment upon the recent article by Perry et al "Attending to History" in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration. We welcome the engagement with power, history and heuristics in the Perry et al paper. Our article discusses the importance of researcher positionality in Major System Change research, alongside managerial power and the centrality of politics to remaking health and care services. Additionally, we highlight the work of Ansell and Gash focused on 'collaborative governance' and its potential to offer insight in relation to Major System Change.</p
Prevalence and relative risk of rotavirus gastroenteritis in children under five years in Nigeria:A systematic review and meta-analysis
Get PDFRotavirus is responsible for most cases of gastroenteritis and mortality in children below 5 years of age, especially in developing countries, including Nigeria. Nonetheless, there is limited data on the nationwide estimate for the prevalence of rotavirus. This systematic review and meta-analysis sought to determine the pooled prevalence of rotavirus infections and its relative risk among children below 5 years of age in Nigeria. Eligible published studies between 1982 and 2021 were accessed from ‘PubMed’, ‘Science Direct’, ‘Google Scholar’ and ‘African Journal Online’, ‘Web of Science’, ‘Springer’, ‘Wiley’ were systematically reviewed. The pooled prevalence, relative risk and regional subgroup analyses were calculated using the random effects model at 95% confidence interval (CI). A total of 62 selected studies, including 15 studies case-control studies, were processed in this review from a pooled population of 18,849 children. The nationwide pooled prevalence of rotavirus among children below 5 years of age in Nigeria was 23% (CI 95%; 19–27). Regional subgroup analysis showed that the Southern region had a prevalence of 27% (CI 95%; 21–32) while the Northern region had a 20% (CI 95%; 16–25%) prevalence, although the difference was not significant (P = 0.527). Rotavirus was implicated in most cases of acute gastroenteritis with a relative risk of 5.7 (95% CI: 2.9–11.2). The high prevalence and relative risk of rotavirus infections among children in Nigeria shows that rotavirus is an important cause of acute gastroenteritis in Nigeria. Thus, there is a need for further surveillance, especially at community levels together with the introduction of rotavirus vaccines into the national immunization program
Adaptive Hybrid Iterative Linearization Algorithms for IM/DD Optical Transmission Systems
Get PDFFor optical field recovery and linear dispersion compensation, we propose a performance-enhanced linearization algorithm, termed adaptive hybrid multi-constraint iteration algorithm (MCIA), which does not require any physical modifications to standard configurations of intensity-modulation and direct-detection (IM/DD) transmission systems. To improve the sensitivity to the residual inter-symbol interference (ISI) effect, we introduce, after fiber backward-propagation, a linear feed-forward equalizer (FFE) pair into the proposed algorithm. To improve the sensitivity to fiber dispersion estimation errors, we utilize a two-stage dispersion estimator coupled with the G-S iteration. After 100-Gb/s PAM-4 signal transmissions over 400-km fibers, the simulation results show that the MCIA offers an 1.5-dB optical signal-to-noise ratio (OSNR) gain and an 1-dB optical power budget improvement compared with the decision-directed data-aided iterative algorithm (DD-DIA), for highly dispersive IM/DD transmissions. By performing adaptive dispersion estimation, the MCIA has higher tolerance to estimation errors in fiber length. Moreover, for cases subject to large dispersion, the usage of the embedded FFE pair not only desensitizes the MCIA on the limited bandwidth effect, but also accelerates the convergence performance for reaching lower BERs. We experimentally demonstrate that the proposed algorithm can support 150-Gb/s PAM-4 transmissions over 25-km standard single mode fibers (SSMF), where just a 7-tap FFE-pair is required. For 150 Gb/s transmissions, the tolerance to fiber length estimation error is increased from 0.9 km to 20 km
What is the effectiveness and cost-effectiveness of interventions in reducing the harms for children and young people who have been exposed to domestic violence or abuse: a rapid review.
Get PDFAbstract: Children and young people witnessing domestic violence and abuse (DVA) can be affected negatively in terms of their psychological, emotional, and social development. Adverse events in childhood are known to be harmful to a young persons development and influence their life course, and therefore is a significant public health issue. The aim of this rapid review is to highlight the evidence on effective interventions (and any relevant cost-effectiveness evidence) focusing on reducing the harms for children and young people who have been exposed to DVA. Twenty-five studies were identified along with three guidance documents from the Welsh Government and the National Institute for Health and Care Excellence (NICE) in the UK. Twenty papers from nineteen studies reported the effectiveness of a wide range of interventions to support children and young people who have witnessed DVA. Most studies found meaningful differences in behaviour following an intervention. However, some studies did not find any differences between the intervention and control groups following an intervention to reduce the negative effects of witnessing DVA.An included cost-effectiveness analysis suggested that for behavioural outcomes, a psychoeducational intervention delivered to parent and child in parallel is likely to be cost-effective among the interventions they compared. Two further full economic evaluation studies determined the cost-effectiveness of cognitive behavioural therapy interventions to support children and young people who have been exposed to DVA. Policy and practice implications: Economic evaluations have found preliminary evidence that cognitive therapy is a cost-effective intervention to treat children and adolescents with PTSD. Future interventions should be co-produced with relevant stakeholders and patient and public members (including children and young people).There is a need for larger, well conducted, pragmatic randomised controlled trials with longer follow-up periods. <br/
Asymmetric visual representation of sex from facial appearance
Get PDFWe efficiently infer others’ traits from their faces, and these inferences powerfully shape our social behaviour. Here, we investigated how sex is represented in facial appearance. Based on previous findings from sex-judgment tasks, we hypothesized that the perceptual encoding of sex is not balanced but rather polarized: for the processes that generate a sex percept, the default output is “male,” and the representation of female faces extends that of the male, engaging activity over unique detectors that are not activated by male faces. We tested this hypothesis with the logic of Treisman’s studies of visual search asymmetries, predicting that observers should more readily detect the presence of female faces amongst male distractors than vice versa. Across three experiments (N = 32 each), each using different face stimuli, we confirmed this prediction in response time and sensitivity measures. We apply GIST analyses to the face stimuli to exclude that the search asymmetry is explained by differences in image homogeneity. These findings demonstrate a property of the coding that links facial appearance with a significant social trait: the female face is coded as an extension of a male default. We offer a mechanistic description of perceptual detectors to account for our findings and posit that the origins of this polarized coding scheme are an outcome of biased early developmental experience
Cognitive versus emotional modulation within a Stroop paradigm in patients with schizophrenia
Get PDFBackgroundSchizophrenia is a complex disorder involving deficits in both cognitive and emotional processes. Specifically, a marked deficit in cognitive control has been found, which seems to increase when dealing with emotional information.AimsWith the aim of exploring the possible common links behind cognitive and emotional deficits, two versions of the emotional Stroop task were administered.MethodIn the cognitive-emotional task, participants had to name the ink colour (while ignoring the meaning) of emotional words. In contrast, the emotional-emotional task consisted of emotional words superimposed on emotional faces, and the participants had to indicate the emotional valence of the faces. Fifty-eight participants (29 in-patients diagnosed with schizophrenia and 29 controls) took part in the study.ResultsPatients and controls showed similar response times in the cognitive-emotional task; however, patients were significantly slower than controls in the emotional-emotional task. This result supports the idea that patients show a more pronounced impairment in conflict modulation with emotional content. Besides, no significant correlations between the tasks and positive or negative symptoms were found. This would indicate that deficits are relatively independent of the clinical status of patients. However, a significant correlation between the emotional-emotional task and cognitive symptoms was found.ConclusionsThese findings suggest a restricted capacity of patients with schizophrenia to deal with the attentional demands arising from emotional stimuli
Earlier cancer diagnosis in primary care: a feasibility economic analysis of ThinkCancer!
Get PDFBackground: UK cancer survival rates are much lower compared with other high-income countries. In primary care, there are opportunities for GPs and other healthcare professionals to act more quickly in response to presented symptoms that might represent cancer. ThinkCancer! is a complex behaviour change intervention aimed at primary care practice teams to improve the timely diagnosis of cancer.Aim To explore the costs of delivering the ThinkCancer! intervention to expedite cancer diagnosis in primary care.Design & setting: Feasibility economic analysis using a micro-costing approach, which was undertaken in 19 general practices in Wales, UK.Method: From an NHS perspective, micro-costing methodology was used to determine whether it was feasible to gather sufficient economic data to cost the ThinkCancer! intervention. Owing to the COVID-19 pandemic, ThinkCancer! was mainly delivered remotely online in a digital format. Budget impact analysis (BIA) and sensitivity analysis were conducted to explore the costs of face-to-face delivery of the ThinkCancer! intervention as intended pre-COVID-19.Results: The total costs of delivering the ThinkCancer! intervention across 19 general practices in Wales was £25 030, with an average cost per practice of £1317 (standard deviation [SD]: 578.2). Findings from the BIA indicated a total cost of £34 630 for face-to-face delivery.Conclusion: Data collection methods were successful in gathering sufficient health economics data to cost the ThinkCancer! intervention. Results of this feasibility study will be used to inform a future definitive economic evaluation alongside a pragmatic randomised controlled trial (RCT)
Suitability of aircraft wastewater for pathogen detection and public health surveillance
Get PDFInternational air travel is now widely recognised as one of the primary mechanisms responsible for the transnational movement and global spread of SARS-CoV-2. Monitoring the viral load and novel lineages within human-derived wastewater collected from aircraft and at air transport hubs has been proposed as an effective way to monitor the importation frequency of viral pathogens. The success of this approach, however, is highly dependent on the bathroom and defecation habits of air passengers during their journey. In this study of UK adults (n = 2103), we quantified the likelihood of defecation prior to departure, on the aircraft and upon arrival on both short- and long-haul flights. The results were then used to assess the likelihood of capturing the signal from infected individuals at UK travel hubs. To obtain a representative cross-section of the population, the survey was stratified by geographical region, gender, age, parenting status, and social class. We found that an individual's likelihood to defecate on short-haul flights (< 6 h in duration) was low (< 13 % of the total), but was higher on long-haul flights (< 36 %; > 6 h in duration). This behaviour pattern was higher among males and younger age groups. The maximum likelihood of defecation was prior to departure (< 39 %). Based on known SARS-CoV-2 faecal shedding rates (30-60 %) and an equal probability of infected individuals being on short- (71 % of inbound flights) and long-haul flights (29 %), we estimate that aircraft wastewater is likely to capture ca. 8-14 % of SARS-CoV-2 cases entering the UK. Monte Carlo simulations predicted that SARS-CoV-2 would be present in wastewater on 14 % of short-haul flights and 62 % of long-haul flights under current pandemic conditions. We conclude that aircraft wastewater alone is insufficient to effectively monitor all the transboundary entries of faecal-borne pathogens but can form part of a wider strategy for public heath surveillance at national borders.</p
The importance of resolving nearshore currents in coastal dispersal models
Get PDFBiophysical models often require shelf-scale domains to map larval dispersal over several weeks, presenting a computational challenge. This can be overcome by decreasing model spatial resolution; however, nearshore processes, which potentially play a significant role in larval dispersal, will inevitably be unresolved. Here, we evaluate how simulated larval dispersal in the nearshore is sensitive to model spatial resolution. We use an unstructured, finite element, hydrodynamic model of a topographically-complex coastline in North Wales, UK (which includes headlands, bays and channels) at four different spatial scales (50, 100, 250, 500 m) to compare the influence of spatial resolution on transport and dispersal patterns of particles released within the nearshore region (within 1 km of the shore). In the higher resolution (50 and 100 m) simulations, particles generally travelled offshore more quickly and further (18%) than in the coarser (250 and 500 m) simulations. This had important implications for potential connectivity along the coast: for the lower resolution simulations, retention of particles near source sites was increased by 50% and, whilst the magnitude of connectivity among discrete regions along the coast was also increased (by 27%), the number of connected regions was reduced (by 9%), compared with the higher resolution simulations. Our results, based on a case study in a highly energetic and topographically complex region, suggest that model spatial resolution of 100 m should be used for dispersal studies in the nearshore zone. These findings add to growing evidence of the importance of using appropriately scaled models when simulating the transport of material within – and out of – the coastal zone, with many applications, such as marine ecology, marine biosecurity, marine spatial planning and marine pollution
EEG correlates of verbal and conscious processing of motor control in sport and human movement: A systematic review
Get PDFStudies from the sport and human movement sciences have proposed that electroencephalographic (EEG) measures of left-temporal alpha power and left-temporal-frontal connectivity reflect verbal, conscious processing during the learning and control of motor skills. The aim of this systematic review was to synthesize these studies, bring awareness to key methodological considerations, and suggest future research agendas and practices to help generate new knowledge on this topic. An extensive search of electronic databases (PubMed, PsychInfo, GoogleScholar, and SportDiscus) was conducted to identify peer-reviewed literature relating to EEG, conscious movement control and verbal processing. Thirty-eight studies met the inclusion criteria and were retained for quality assessment and synthesis of results. Results suggested that only 36% of studies measuring left-temporal alpha power and only 47% of studies measuring left-temporal-frontal connectivity supported their putative association with verbally-guided, conscious motor processing. There were great methodological inconsistencies across studies and overall studies scored moderate for quality criteria. In conclusion, we question the use of these EEG indices as markers of verbally-guided conscious control until more substantive evidence of their efficacy is provided and stronger methodologies are adopted. We outline six recommendations that can be used to guide such work in the future