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Entry points for supporting middle-tier officials in foundational learning reforms: equip, connect, inform, empower
Get PDFThis synthesis brief identifies and explains four entry points for supporting middle-tier officials – equip, connect, inform, and empower – which are essential for strengthening foundational learning reforms in education systems, particularly across the Global South. Middle-tier officials act as intermediaries between top policymakers and school-level actors; this document synthesises evidence and practice across contexts and disciplines to show why these entry points matter, how they have appeared in practice, and what implications they have for practitioners, funders, and researchers. It also includes a case example from the Tusome structured pedagogy programme in Kenya and outlines a research agenda for future work
Time matters: chronology in the European Mesolithic
Get PDFA robust chronology is essential for providing a framework within which various technological and social aspects of Mesolithic societies can be investigated. It is also crucial in the search for potential consequences of environmental change on human societies over the millennia that constitute the European Mesolithic. This chapter reviews developments in radiocarbon dating and their impact on our ability to construct increasingly high-resolution chronologies. Some challenges are also highlighted, most notably the imprecision created by marine and freshwater reservoir effects. A series of kernel density estimation (KDE) plots on dated human remains from various western European countries are presented and discussed. While the search for finer-scale chronologies is important, it is argued that this needs to be complemented by a consideration of long-term processes acting well beyond the range of individual human lifetimes. Time operates on different scales that are relevant for different kinds of questions
Changes in the regional water cycle and their impact on societies
Get PDFChanges in “blue water”, which is the total supply of fresh water available for human extraction over land, are quite closely related to changes in runoff or equivalently precipitation minus evaporation, . This article examines how climate change-driven recent past and future changes in the regional water cycle relate to blue water availability and changes in human blue water demand. Although at the largest scales theoretical and numerical model predictions are in broad agreement with observations, at continental scales and below models predict large ranges of possible future and runoff especially at the scale of individual river catchments and for shorter timescale subseasonal floods and droughts. Nevertheless, it is expected that the occurrence and severity of floods will increase and that of droughts may increase, possibly compounded by human-driven non-climatic changes such as changes in land use, dam water impoundment, irrigation and extraction of groundwater. Contemporary assessments predict that increases in 21st century human water extraction in many highly-populated regions are unlikely to be sustainable given projections of future . To reduce uncertainty in future predictions, there is an urgent need to improve modeling of atmospheric, land surface and human processes and how these components are coupled. This should be supported by maintaining the observing network and expanding it to improve measurements of land surface, oceanic and atmospheric variables. This includes the development of satellite observations stable over multiple decades and suitable for building reanalysis datasets appropriate for model evaluation
Integrating metagenomic sequencing into diagnostic pathways for tuberculous meningitis – authors' reply
Get PDFSystematic review and meta-analysis of mobilisation following open reduction and internal fixation of hand fractures
Get PDFDelayed mobilisation following open reduction and internal fixation (ORIF) of hand fractures may contribute to stiffness and poor functional recovery. The aim of this systematic review and meta-analysis was to evaluate whether timing of mobilisation post-ORIF impacts patient-reported and clinical post-operative outcomes.The review was conducted according to the Cochrane Handbook and was reported in concordance with PRISMA guidelines. All studies reporting mobilisation regimens following ORIF performed within two weeks of metacarpal or phalangeal fractures were included. Of 794 abstracts screened, 53 studies were included, evaluating 1822 hand fractures treated with ORIF.We found differences between mobilisation timing in patient-reported outcome measures (PROMs), adverse events and time to radiological fracture union. Immediate mobilisation (≤1 day of ORIF) had the shortest mean bone healing time of 38.7 days (95% CI 34.3, 42.3) compared to early mobilisation (≤7 days) (49.6 days [95% CI 42.8, 56.5]). Delayed mobilisation (>7 days) had the lowest rate of adverse events at 9.3% [95% CI 5.6, 15.2] compared to early mobilisation at 25.0% [95% CI 17.1, 35.0]. However, variable outcome reporting and inconsistent diagnostic criteria limited definitive conclusions.The current literature on post-ORIF mobilisation is heterogeneous. Our meta-analysis demonstrated wide variability in outcomes across different regimens, with overlapping confidence intervals across most summary estimates. A definitive, multi-centre RCT comparing time to mobilisation post-ORIF, including comprehensive outcome reporting and cost-effectiveness analysis, is warranted to inform clinical practice
A review of silicon valley imperialism by Erin McElroy
Get PDFThis review situates the book's contribution to work on the spatial divisions of digital labour, and interrogates its discussions of the fantasies and gendering of technofascism
Efficacy of five strategies to improve stroke action awareness in Spanish-speaking adults: A randomized comparison
Get PDFBackground and Aims: Improving stroke action awareness is challenging in non-English-speaking populations. In this study, we evaluated the effectiveness of five Spanish-language educational tools in improving recognition and making an emergency response to stroke symptoms among Spanish-speaking adults in Mexico. Methods: Spanish-speaking participants were recruited from public spaces. Individuals with a history of stroke were excluded. Participants were randomly assigned to receive an educational session tailored to one of five stroke awareness tools (RAPIDO, DALE, CAMALEON, CORRE, and ICTUS 911). Stroke knowledge was assessed using the Stroke Awareness Questionnaire before the educational intervention and after 6–9 days of follow-up. The primary outcome was the change in the proportions of correctly identified stroke symptoms. Secondary outcomes included changes in participants’ achievement of adequate stroke knowledge in individual FAST domains and their understanding of the appropriate actions to take after identifying stroke symptoms. Results: In data from 435 participants, all strategies improved stroke symptom recognition and risk factor awareness, although no statistically significant differences were observed in the primary outcomes. Changes ranged from 0.35 (DALE) to 0.49 (CAMALEON) for Facial Weakness, the symptom with the largest improvement, and from 0.00 (CAMALEON, CORRE, RAPIDO) to 0.15 (DALE) for Problems with Vision, the symptom with the smallest improvement. For the secondary outcomes, increases in adequate stroke knowledge ranged from 0.18 (CORRE, DALE) to 0.31 (ICTUS 911); between-group comparisons were statistically significant (p = 0.027). Improvements in appropriate action after symptom recognition ranged from 0.09 (RAPIDO) to 0.29 (ICTUS 911), with significant differences across groups (p = 0.034). Conclusions: This study shows that brief educational interventions can improve stroke symptom recognition and intended response in Spanish-speaking adults. Among five strategies, ICTUS 911 yielded the largest short-term gains, supporting its potential utility. Further research is needed to assess long-term effectiveness and broader applicability
Interventions to prevent, reduce, and respond to violence against children and adolescents: a systematic review of systematic reviews to update the INSPIRE Framework
Get PDFEach year, one billion children globally experience violence, which carries lifelong detrimental effects. In 2016, WHO and partners launched the INSPIRE Framework: seven strategies to end violence against children. A decade after INSPIRE's development, this systematic review updates its evidence base and assesses which interventions could be prioritised for implementation. This systematic review of systematic reviews searched 152 information sources from Jan 1, 2010, to May 15, 2023, to identify systematic reviews evaluating the effectiveness of policies or interventions in addressing violence against children. Reviews were narratively synthesised and interventions were ranked using a decision matrix based on the amount and quality of evidence and the consistency of effectiveness. From 22 117 initial articles screened, 216 unique systematic reviews were included, of which 149 focused on interventions that do not have WHO implementation guidelines. Of these 149 reviews, 47 (32%) were assessed to be high or moderate confidence using the AMSTAR2 tool. Across outcome domains and countries, the strongest evidence of effectiveness includes parenting programmes for reducing child maltreatment, safe and enabling school environments (whole-school approaches) for preventing youth violence, healthy romantic relationships education for reducing adolescent intimate partner violence, cash-plus life-skills training among adolescents in low-income and middle-income countries for reducing youth violence (including sexual violence), and cognitive behavioural therapy for children exposed to violence. Parenting programmes might also reduce maternal intimate partner violence, although few studies have directly examined this outcome. Scaling up these evidence-based approaches is essential to ending violence against children. This study was registered with PROSPERO (CRD42023427487)
A retrospective observational study of effectiveness of sequential biologic and targeted synthetic DMARDs in psoriatic arthritis in the UK
Get PDFObjectives: Evidence evaluating effectiveness of biologic and targeted synthetic DMARDs (b/tsDMARDs) in adults with PsA after exposure to three or more b/tsDMARDs is lacking. We aimed to evaluate response to sequential lines of b/tsDMARDs. Methods: In this multicentre retrospective observational study, 22 hospitals submitted data from routine clinic appointments of patients with PsA treated with b/tsDMARDs. Purposive sampling obtained a study population exposed to advanced lines of therapy. Effectiveness outcome measures (Psoriatic Arthritis Response Criteria [PsARC]/tender joint count [TJC]/swollen joint count [SJC]) at baseline and first follow-up (12–16 weeks) for each line were recorded. Odds of achieving PsARC in 2nd/3rd line were compared with 4th+ line. Results: Four hundred and thirty-seven participants (163 male, 274 female) and 1459 treatment courses were included: 430 1st line, 633 2nd/3rd line and 396 4th+ line. The adjusted odds ratio (95% CI) for achieving PsARC in 1st line vs 2nd/3rd line was 1.91 (1.40, 2.60) and 4th+ line vs 2nd/3rd line was 1.13 (0.84, 1.55). There was no significant difference in change from baseline TJC/SJC between 2nd/3rd and 4th+ lines. Conclusion: In this cohort the highest chance of a positive PsARC response was to 1st line b/tsDMARD: twice the chance of response vs 2nd/3rd line. The chance of a positive PsARC response to 4th+ lines of b/tsDMARD was not significantly different from 2nd/3rd lines after adjustment. This indicates that patients in a UK cohort can continue to have a meaningful response to later lines of treatment. This is the first available evidence of response to later lines of b/tsDMARD treatment in PsA
Summer and SERT: effect of daily sunshine hours on SLC6A4 promoter methylation in seasonal affective disorder
Get PDFObjectives: Knowledge on how sunlight impacts SERT activity via SLC6A4 promoter methylation in Seasonal Affective Disorder (SAD) remains limited. This study aimed to investigate the effect of daily sunshine duration on SLC6A4 promoter methylation in 28 patients with SAD and 40 healthy controls (HC).
Methods: Daily sunlight data for Vienna, Austria (mean of 28 days before blood sampling), were obtained from ©GeoSphere Austria. A general linear model analysed SLC6A4 promoter methylation as the dependent variable, with sunlight hours as the independent variable, and group (SAD, HC), age, sex, and 5-HTTLPR/rs25531 as covariates. Exploratory analyses examined the effects of sunlight hours and methylation on Beck Depression Inventory (BDI) scores.
Results: Sunlight had a significant effect on SLC6A4 promoter methylation (p = 0.03), with more sunlight hours resulting in lower methylation (r = −0.25). However, the interaction between sunlight and group was non-significant, suggesting a rather general effect across both groups. Sunlight also influenced BDI scores (p < 0.01), with fewer sunlight hours leading to higher scores (r = −0.25), which aligns with previous research. SLC6A4 promoter methylation had no significant effect on BDI scores.
Conclusions: Our findings suggest that sunlight influences SLC6A4 methylation without SAD specificity