44 research outputs found
The impact of the first year of the COVID-19 pandemic on canine rabies control efforts: a mixed-methods study of observations about the present and lessons for the future
No full textAchieving zero human deaths from dog-mediated rabies has been set as a global target for 2030. However, the COVID-19 pandemic has disrupted essential health services across the world, with disproportionate impacts on Neglected Tropical Diseases. Through a mixed-method study using stakeholder questionnaires and in-depth interviews, we examined the scale and nature of disruption from the first year of the pandemic to rabies control programs, and reflected on lessons for the future. Study participants included practitioners and policymakers working in government, academia, international organizations, and the pharmaceutical industry across 48 countries, mainly in Africa and Asia. Mass dog vaccination, essential to rabies control, was most heavily impacted and in 2020, was carried out as planned in just 5% of surveyed countries. Access to post-exposure prophylaxis (PEP) also decreased due to fear of COVID-19 infection and difficulties in reaching health care centers. Dog vaccination and PEP delivery suffered from disruptions to the importation and distribution of vaccines. School closures affected rabies awareness activities and, when public events moved online, they could not reach the most disadvantaged groups. Surveillance, already weak, was severely disrupted by movement restrictions which, together with reduced demand for PEP, exacerbated under-reporting. Participants reported growing complaints around free-roaming dogs, with numbers likely to have increased in some settings. In some countries, dog rabies outbreaks and human rabies cases were already ascribed to the pandemic, but further impacts are likely still to be realized. Meanwhile, decreased demand for PEP from COVID-19 constraints could lead to reduced procurement in future. In the wake of post-COVID-19 demands on health services, there is an opportunity for veterinary services to show leadership in progressing the Zero by 30 agenda, particularly in scaling up mass dog vaccination within and across countries, as well as potential to make better use of community-based vaccinators. Countries must further secure stable procurement of dog and human vaccines, classifying them as essential goods prioritized for import and where needed, through sharing of stocks. Dedicated telemedicine services also show promise, for example through fostering participatory disease surveillance, including Integrated Bite Case Management, and delivering up-to-date instructions on the closest sources of PEP
The Spatial Impacts of a Massive Rail Disinvestment Program: The Beeching Axe
No full textTransport investment is a popular policy instrument and many recent studies have investigated whether new infrastructure generates economic benefits and has spatial economic impacts. Our work approa ches the question differently and looks at what happens when a substantial part of a national railway network is dismantled, as happened during the 1950s, 60s and 70s in Britain. Part of this disinvestment occurred following controversial reports on railwa y profitability and structure in the early 1960s – a course of action known colloquially as ‘the Beeching Axe’ after the author of the reports. The removal of railways is often blamed for the decline of rural areas and peripheral towns in post -war Britain. This rail disinvestment program was targeted at removal of underused and unprofitable lines and not specifically targeted at local economic performance. Even so, we find that there is a relationship between pre -war population decline and the depth of the rail cuts in the post 1950 period. Conditional on these pre -trends, we show that loss of access by rail did cause relative population decline, decline in the proportion of skilled workers, and decline in the proportion of young people in affected areas. The elasticity of population with respect to changes in centrality (or mark et access) is around 0.3 in our main estimates. Instrumental variables estimates based on the network structure of the cuts yield higher elasticities. An implication of these findings is that rail transport infrastructure plays an important role in shaping the spatial structure of the economy
The spatial impacts of a massive rail disinvestment program: the Beeching Axe
No full textTransport investment is a popular policy instrument and many recent studies have investigated whether new infrastructure generates economic benefits and has spatial economic impacts. Our work approaches the question differently and looks at what happens when a substantial part of a national railway network is dismantled, as happened during the 1950s, 60s and 70s in Britain. Part of this disinvestment occurred following controversial reports on railway profitability and structure in the early 1960s – a course of action known colloquially as ‘the Beeching Axe’ after the author of the reports. The removal of railways is often blamed for the decline of rural areas and peripheral towns in post-war Britain. This rail disinvestment program was targeted at removal of underused and unprofitable lines and not specifically targeted at local economic performance. Even so, we find that there is a relationship between pre-war population decline and the depth of the rail cuts in the post 1950 period. Conditional on these pre-trends, we show that loss of access by rail did cause relative population decline, decline in the proportion of skilled workers, and decline in the proportion of young people in affected areas. The elasticity of population with respect to changes in centrality (or market access) is around 0.3 in our main estimates. Instrumental variables estimates based on the network structure of the cuts yield higher elasticities. An implication of these findings is that rail transport infrastructure plays an important role in shaping the spatial structure of the economy
Training and assessment of medical specialists in clinical microbiology and infectious diseases in Europe
No full textBackground: There is wide variation in the availability and training of specialists in the diagnosis and management of infections across Europe. Objectives: To describe and reflect on the current objectives, structure and content of European curricula and examinations for the training and assessment of medical specialists in Clinical (Medical) Microbiology (CM/MM) and Infectious Diseases (ID). Sources: Narrative review of developments over the past two decades and related policy documents and scientific literature. Content: Responsibility for curricula and examinations lies with the European Union of Medical Specialists (UEMS). The ID Section of UEMS was inaugurated in 1997 and the MM Section separated from Laboratory Medicine in 2008. The sections collaborate closely with each other and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Updated European Training Requirements (ETR) were approved for MM in 2017 and ID in 2018. These comprehensive curricula outline the framework for delivery of specialist training and quality control for trainers and training programmes, emphasizing the need for documented, regular formative reviews of progress of trainees. Competencies to be achieved include both specialty-related and generic knowledge, skills and professional behaviours. The indicative length of training is typically 5 years; a year of clinical training is mandated for CM/MM trainees and 6 months of microbiology laboratory training for ID trainees. Each Section is developing examinations using multiple choice questions to test the knowledge base defined in their ETR, to be delivered in 2022 following pilot examinations in 2021. Implications: The revised ETRs and European examinations for medical specialists in CM/MM and ID provide benchmarks for national authorities to adapt or adopt locally. Through harmonization of postgraduate training and assessment, they support the promotion and recognition of high standards of clinical practice and hence improved care for patients throughout Europe, and improved mobility of trainees and specialists. Nick J. Beeching, Clin Microbiol Infect 2021;27:1581 (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/)
Direct speech, subjectivity and speaker positioning in London English and Paris French
No full textThis paper examines functional similarities and differences in the use of pragmatic features – in particular quotatives and general extenders – on the right and left periphery of direct quotations. This comparative study, based on the analysis of a contemporary corpus of London English and Paris French (MLE – MPF) , finds that the form and frequency of these particles tend to vary not only with respect to social factors such as speakers’ age and gender, but also with respect to the different pragmatic functions they come to perform in different interactional settings. The contemporary data is analysed both qualitatively and quantitatively to show how different variants position the speaker in relation to: i) the content of the quote, ii) the interlocutors, iii) the presumed author of the quote. The paper aims to contribute to a better understanding of pragmatic universals and variability in the use of direct speech
Beeching, Sarah Margaret, (born 9 Sept. 1969), Founder and Executive Director, Oshun Partnership, since 2011
No full textBrucella melitensis prosthetic joint infection in a traveller returning to the UK from Thailand: Case report and review of the literature
No full textSummaryBackgroundBrucella spp. prosthetic joint infections are infrequently reported in the literature, particularly in returning travellers, and optimal treatment is unknown.MethodWe describe a prosthetic joint infection (PJI) caused by Brucella melitensis in a traveller returning to the UK from Thailand, which we believe to be the first detailed report of brucellosis in a traveller returning from this area. The 23 patients with Brucella-related PJI reported in the literature are summarised, together with our case.ResultsThe diagnosis of Brucella-related PJI is difficult to make; only 30% of blood cultures and 75% of joint aspiration cultures were positive in the reported cases. Culture of intraoperative samples provides the best diagnostic yield. In the absence of radiological evidence of joint loosening, combination antimicrobial therapy alone may be appropriate treatment in the first instance; this was successful in 6/7 [86%] of patients, though small numbers of patients and the likelihood of reporting bias warrant caution in drawing any firm conclusions about optimal treatment. Aerosolisation of synovial fluid during joint aspiration procedures and nosocomial infection has been described.ConclusionsBrucella-related PJI should be considered in the differential of travellers returning from endemic areas with PJI, including Thailand. Personal protective equipment including fit tested filtering face piece-3 (FFP3) mask or equivalent is recommended for personnel carrying out joint aspiration when brucellosis is suspected. Travellers can reduce the risk of brucellosis by avoiding unpasteurised dairy products and animal contact (particularly on farms and abattoirs) in endemic areas and should be counselled regarding these risks as part of their pre-travel assessment
Emerg Infect Dis
No full textWe report a case-control study of sporadic cryptosporidiosis with genotyping of isolates from case-patients. A postal questionnaire was completed by 427 patients and 427 controls. We obtained genotyping data on isolates from 191 patients; 115 were Cryptosporidium hominis, and 76 were C. parvum. When all cryptosporidiosis cases were analyzed, three variables were strongly associated with illness: travel outside the United Kingdom, contact with another person with diarrhea, and touching cattle. Eating ice cream and eating raw vegetables were both strongly negatively associated with illness. Helping a child <5 years of age to use the toilet and the number of glasses of tap water drunk at home each day were also independently positively associated with risk. Eating tomatoes was negatively associated. For C. hominis infections, the strongly significant risk factors were travel abroad and changing diapers of children <5 years of age. For C. parvum, eating raw vegetables and eating tomatoes were strongly negatively associated with illness; touching farm animals was associated with illness
Learning from each other: identifying further needs for older adult programming at four Canadian Mental Health Association regional branches from the perspectives of front line staff
No full textThe purpose of this project is to review existing programs that are available to the older adult population aged 55 and over with Mental Health issues at four BC Canadian Mental Health Association (CMHA) branches, with a focus on service providers‟ perceptions of program opportunities. The selected branches include Vancouver-Fraser (CMHA-VF) branch, North and West Vancouver, Shuswap-Revelstoke, and Kelowna branches. The reason for conducting research on this topic is to determine what types of targeted programming might best support regional older adults with mental health concerns. Data was collected using FluidSurveys, and the survey questions allowed for both qualitative and quantitative data. The questions encouraged participants to share their views as front-line staff who work with clients, and what they determine to be effective programs for older adults versus in their view, and what they believe their agency may be able to benefit from, for future programming. Five thematic categories were developed from participants‟ feedback: stigma, education and outreach, leisure/recreational/social wellness programs, how to access resources and future older adult programming. These themes demonstrate not only the work front-line staff members are currently doing within the agency, but also areas of program development that are identified. A theoretical framework of Erik Erikson‟s life span development perspective, and exploring the various social determinants of health, provides a foundation for understanding why older adults experience social exclusion and are denied the opportunity to gain access to resources
Rabies and the pandemic: lessons for One Health
No full textThis article examines the impact of coronavirus disease 2019 (COVID-19) on dog-mediated rabies, a neglected tropical disease that remains endemic in >65 countries. A globally agreed strategy for rabies elimination is underpinned by a One Health approach, coordinating human and animal health sectors and engaging communities. We present data on the scale and nature of COVID-19 disruption to rabies control programmes and the wider learning for One Health implementation. We argue that the global shift in health priorities caused by the pandemic, and consequent side-lining of animal health, will have broader ramifications for One Health implementation and preparedness for future emergent zoonoses
