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Novel and optimized diagnostics for pediatric TB in endemic countries: NOD-pedFEND study protocol
Get PDFBackground: Pediatric tuberculosis is a major global public health challenge, with reliable diagnosis being a main obstacle to identifying and treating affected children. New and improved diagnostics, ideally on non-sputum samples, are urgently required, especially in the most vulnerable group of children under five years of age. Studies to date have been limited by small sample sizes and few bacteriologically-confirmed cases. Here, we describe the study protocol of the NIH-funded NOD-pedFEND study, which will be one of the largest diagnostic studies to date of children at greatest risk of tuberculosis. Methods: In this prospective observational cohort study, we aim to evaluate existing and novel diagnostic assays, including pathogen- and host-based tests and combinations of tests. A consecutive cohort of children under five years of age with signs and symptoms of tuberculosis is enrolled in Uganda and Peru. All children undergo an extensive baseline workup with signs- and symptoms recording, microbiological reference tests, chest X-ray and tuberculin skin test for rigorous classification according to internationally recognized microbiological, composite reference and strict standards. An array of samples is collected for investigational tests. Follow-up visits are conducted at 2 weeks, 2 months and 6 months. A small cohort of healthy controls is enrolled to evaluate the specificity of selected diagnostics. The study has been approved by the relevant institutional review boards. Discussion: With this large cohort study of children under five years of age, we aim to make an important contribution to the evaluation of new diagnostics for pediatric tuberculosis. By establishing a comprehensive biorepository, the study will also enable the assessment of novel tests as they become available during and after the study
Investigators are human too: outcome bias and perceptions of individual culpability in patient safety incident investigations
Get PDFBackground: Healthcare patient safety investigations inappropriately focus on individual culpability and the target of recommendations is often on the behaviours of individuals, rather than addressing latent failures of the system. The aim of this study was to explore whether outcome bias might provide some explanation for this. Outcome bias occurs when the ultimate outcome of a past event is given excessive weight, in comparison to other information, when judging the preceding actions or decisions. Methods: We conducted a survey in which participants were each presented with three incident scenarios, followed by the findings of an investigation. The scenarios remained the same, but the patient outcome was manipulated. Participants were recruited via social media and we examined three groups (general public, healthcare staff and experts) and those with previous incident involvement. Participants were asked about staff responsibility, avoidability, importance of investigating and to select up to five recommendations to prevent recurrence. Summary statistics and multilevel modelling were used to examine the association between patient outcome and the above measures. Results: 212 participants completed the online survey. Worsening patient outcome was associated with increased judgements of staff responsibility for causing the incident as well as greater motivation to investigate. More participants selected punitive recommendations when patient outcome was worse. While avoidability did not appear to be associated with patient outcome, ratings were high suggesting participants always considered incidents to be highly avoidable. Those with patient safety expertise demonstrated these associations but to a lesser extent, when compared with other participants. We discuss important comparisons between the participant groups as well as those with previous incident involvement, as victim or staff member. Interpretation: Outcome bias has a significant impact on judgements following incidents and investigations and may contribute to the continued focus on individual culpability and individual focused recommendations observed following investigations
Universities and the Contested Creation of the Elite
Get PDFFor centuries universities have been a locus of elite creation. In the Middle Ages, university‐trained elites were leaders of the Church, served in secular lords' administrations and staffed the judiciary. Over time, their scope has expanded to include leadership in governments, corporations, and civil society more broadly. Universities play two roles in the creation of the elite: selection and education. Both of these have historically been the subject of intense contestation, with the outcomes shaping a range of political and economic outcomes. In this piece, I synthesize work on educational institutions' creation of the elite, discussing both historical and contemporary cases of contestation of this process and their outcomes. I close with a discussion of the implications for our understanding of university‐based protest movements
Spatiotemporal dynamics of fetal liver hematopoietic niches
Get PDFEmbryonic hematopoietic cells develop in the fetal liver (FL), surrounded by diverse non-hematopoietic stromal cells. However, the spatial organization and cytokine production patterns of the stroma during FL development remain poorly understood. Here, we characterized and mapped the hematopoietic and stromal cell populations at early (E12.5-14.5) FL stages, revealing that while hepatoblasts were the primary source of hematopoietic growth factors, other stromal cells-including mesenchymal, mesothelial, and endothelial cells-also contributed to this signaling network. Using a dedicated image analysis pipeline, we quantified cell distances to tissue structures and defined neighbor relationships, uncovering that different hematopoietic progenitors exhibit distinct preferences for neighboring stromal cells and show developmental changes in spatial distribution. Notably, our data suggest that the sub-mesothelium region plays a prominent role in early fetal hematopoiesis. This approach offers a valuable tool for studying complex cellular interactions in biological systems, providing new insights into hematopoietic niche organization during development
Priced out of belonging? Insufficient concessions on membership fees across international societies in ecology and evolution
Get PDFLearned societies, as professional bodies for scientists, are an integral part of the scientific system. However, their membership fees have the potential to be prohibitive to the most vulnerable members of the scientific community. To shed light on how membership fees are structured, we conducted a survey of 182 international learned societies relevant to researchers in ecology and evolution. We found that 83% of these societies offered fee concessions to students, but only 26% to postdoctoral researchers. An average regular membership fee—US27.4 (42.7% of the regular fee) and postdoctoral fee—US$42.7 (52.9%). Other types of individual concessions, such as for emeritus, family or unemployed, were rare (2–20%). Of the surveyed societies, 43% had discounts for members from developing countries (Global South). Such discounts were more common among societies located in high-income countries. Societies with a publicly visible commitment to equity, diversity and inclusion were more likely to offer different types of concessions. Currently, fees may prevent researchers from vulnerable and underprivileged groups from accessing multiple professional benefits offered by learned societies in ecology and evolution. This includes postdoctoral researchers, who should receive more support. We recommend tangible actions towards making learned societies more affordable and accessible
The hidden intellectual work of teacher educators: preserving signature pedagogies during policy reform
No full textIn England, the ITT Market Review required all initial teacher education (ITE) providers to review their programmes against a set of government-mandated criteria for accreditation. This paper explores the hidden intellectual work of teacher educators as they adapt their programmes in the light of this change. Whilst research on the impact of teacher education policy can often frame teacher educators as lacking agency, our contention is that teacher educators are highly adaptive and flexible, making adjustments to their practices as needed. Based on interviews conducted with teacher educators working within 14 research-intensive universities, we capture their thinking, planning and dilemmas, presented as two vignettes. The analysis uses Shulman’s signature pedagogy to understand how teacher educators have placed importance on particular aspects of their programmes while working through the accreditation process. We argue this ‘moment in time’ reveals the often-hidden intellectual work that constitutes planning and designing of teacher education experiences
Cross Validation of Albedo Determination for 1627 Ivar from Three Different Techniques
Get PDFNear-Earth asteroids are of great interest to the scientific community due to their proximity to Earth, making them both potential hazards and possible targets for future missions, as they are relatively easy to reach by spacecraft. A number of techniques and models can be used to constrain their physical parameters and build a comprehensive assessment of these objects. In this work, we compare physical property results obtained from improved HV absolute magnitude values, thermophysical modeling, and polarimetry data for the well-known Amor-class NEO 1627 Ivar. We show that our fits for albedo are consistent with each other, thus demonstrating the validity of this cross-referencing approach, and propose a value for Ivar's albedo of 0.24−0.02+0.04 . Future observations will extend this work to a larger sample size, increasing the reliability of polarimetry for rapid asteroid property characterization as a technique independent of previously established methods and requiring significantly fewer observations
Baseline Clinical Characterization of Participants in the Accelerating Medicines Partnership Schizophrenia Program
Get PDFBackground: This paper focuses on the baseline clinical characterization of the participants in the Accelerating Medicines Partnership Schizophrenia (AMP SCZ) program. The AMP SCZ program is designed to investigate a wide array of clinical variables and biomarkers in a total of 2040 clinical high-risk (CHR) participants and 652 community control (CC) participants. Methods: The dataset analyzed includes 1642 individuals at clinical high risk for psychosis and 519 CCs. Key measures include the Positive Symptoms and Diagnostic Criteria for the Comprehensive Assessment of At-Risk Mental States Harmonized with the Structured Interview for Psychosis-Risk Syndromes, which determined CHR criteria and the severity of attenuated psychotic symptoms (APS). Other measures included the Structured Clinical Interview for DSM-5, scales to assess negative symptoms, depression, suicidal ideation, substance use, social and role functioning, and a selection of patient-reported outcomes. Results: CHR participants presented with more severe ratings on all clinical measures and poorer functioning relative to the CC. There were a few significant small associations between measures of APS and other clinical measures. Conclusion: The results from this study support previous research indicating that CHR individuals face serious clinical challenges beyond the risk of developing psychosis. Findings indicate significant associations among various clinical measures, underscoring the complex nature of the CHR population. Limitations are acknowledged, including the preliminary nature of the data and the need for more in-depth analyses from AMP SCZ papers already in progress. Future work will focus on longitudinal data and further exploration of clinical variables and their relationship with biomarkers
Resident and staff experiences of structural barriers to a housing-based overdose prevention site in Vancouver, Canada: “There is a double standard if you smoke”
Get PDFObjectives: Most overdoses in British Columbia (BC), Canada, occur within housing settings. In response, the provincial government is increasingly implementing housing-based overdose prevention sites (HOPS). Within the context of a contaminated drug supply, and changing consumption practices, there is little research examining the effectiveness of HOPS. The aim of this study was to explore qualitatively how residents and staff experience HOPS, focusing on how this intervention fits into the day-to-day operations of a low-barrier housing facility. Methods: This study was undertaken at a non-profit housing and emergency shelter facility, with a HOPS in Vancouver, BC. We employed rapid-ethnographic methods including six weeks of non-participant observation (> 200 h), three focus groups, 20 informal interviews with residents, and 10 semi-structured interviews with staff. Data were analyzed through an inductive thematic approach. Results: Our results suggest that this facility’s HOPS is underutilized due to a variety of structural factors, the most prominent of these being the lack of inhalation services. This lack of service provision exacerbates overdose vulnerability and stigma. Continued drug consumption near the building and in non-monitored areas inside the building creates challenges for staff in identifying potential overdoses and exposes residents who do not consume drugs to drug use within the building. Conclusion: Housing provision which provides a safer consumption environment to include those who smoke drugs is urgently needed to support both individuals who smoke and those looking to transition from injecting to smoking