29 International collaboration to advance research preparedness and response

Pandemic preparedness and research response bring together multiple disciplines and organizations to coordinate action across geographical and specialty boundaries. At their best, these international collaborations provide rapid, robust answers to key scientific questions. But several recent pandemics, notably coronavirus disease 2019 (COVID-19), have revealed less than ideal levels of international collaboration. This chapter discusses factors that limit collaboration and some of the risks of a global research response ecosystem prone to delay and error. Using several case studies as examples, this chapter proposes measures to better prepare and implement international collaborations in future outbreaks, including the strategic allocation of funding to support well-designed, expedited clinical research to answer key clinical and public health questions

Zika: structuring the European research response

Studies are needed to assess #Zika virus risks and to develop diagnostic tests http://ow.ly/ZaOZw

"If I have a cancer, it is not my fault I am a refugee”: A qualitative study with expert stakeholders on cancer care management for Syrian refugees in Jordan

Background Noncommunicable diseases including cancer are widespread amongst the 5.6 million Syrian refugees currently hosted in the Middle East. Given its prevalence as the third leading cause of death in Syria, cancer is likely to be an important health burden among Syrian refugees. Against this background, our aim was to describe the clinical, ethical and policy decision-making experiences of health actors working within the current refugee cancer care system; the impact of refugee cancer care health policies on health care providers and policy makers in this context; and provide suggestions for the way delivery of care should be optimised in a sustained emergency situation. Methods From April-July 2016, we conducted in-depth interviews with 12 purposively sampled health officials and health care workers from the Jordanian Ministry of Health, multilateral donors and international non-governmental organisations. Data were analysed using a framework analysis approach to identify systemic, practical and ethical challenges to optimising care for refugees, through author agreement on issues emerging from the data and those linked more directly to areas of questioning. Results As has been previously reported, central challenges for policy makers and health providers were the lack of quality cancer prevalence data to inform programming and care delivery for this refugee population, and insufficient health resource allocation to support services. In addition, limited access to international funding for the host country, the absence of long-term funding schemes, and barriers to coordination between institutions and frontline clinicians were seen as key barriers. In this context where economic priorities inevitably drive decision-making on public health policy and individual care provision, frontline healthcare workers and policy makers experienced significant moral distress where duties of care and humanitarian values were often impossible to uphold. Conclusions Our findings confirm and expand understanding of the challenges involved in resource allocation decisions for cancer care in refugee populations, and highlight these for the particular situation of long term Syrian refugees in Jordan. The insights offered by frontline clinicians and policy makers in this context reveal the unintended personal and moral impact of resource allocation decisions. With many countries facing similar challenges in the provision of cancer care for refugees, the lessons learned from Jordan suggest key areas for policy revision and international investment in developing cancer care policies for refugees internationally

An evidence-based framework for priority clinical research questions for COVID-19

Background On 31 December, 2019, the World Health Organization China Country Office was informed of cases of pneumonia of unknown aetiology. Since then, there have been over 75000 cases globally of the 2019 novel coronavirus (COVID-19), 2000 deaths, and over 14000 cases recovered. Outbreaks of novel agents represent opportunities for clinical research to inform real-time public health action. In 2018, we conducted a systematic review to identify priority research questions for Severe Acute Respiratory Syndrome-related coronavirus (SARS-CoV) and Middle East Respiratory Syndrome-related coronavirus (MERS-CoV). Here, we review information available on COVID-19 and provide an evidenced-based framework for priority clinical research in the current outbreak. Methods Three bibliographic databases were searched to identify clinical studies published on SARS-CoV and MERS-CoV in the outbreak setting. Studies were grouped thematically according to clinical research questions addressed. In February 2020, available information on COVID19 was reviewed and compared to the results of the SARS-CoV and MERS-CoV systematic review. Results From the research objectives for SARS-CoV and MERS-CoV, ten themes in the literature were identified: Clinical characterisation, prognosis, diagnosis, clinical management, viral pathogenesis, epidemiological characterisation, infection prevention and control/transmission, susceptibility, psychosocial, and aetiology. For COVID19, some information on clinical presentation, diagnostic testing, and aetiology is available but many clinical research gaps have yet to be filled. Conclusions Based on a systematic review of other severe coronaviruses, we summarise the state of clinical research for COVID-19, highlight the research gaps, and provide recommendations for the implementation of standardised protocols. Databased on internationally standardised protocols will inform clinical practice real-time

Isolation Facilities for Highly Infectious Diseases in Europe – A Cross-Sectional Analysis in 16 Countries

International audienceBackground: Highly Infectious Diseases (HIDs) are (i) easily transmissible form person to person; (ii) cause a life-threatening illness with no or few treatment options; and (iii) pose a threat for both personnel and the public. Hence, even suspected HID cases should be managed in specialised facilities minimizing infection risks but allowing state-of-the-art critical care. Consensus statements on the operational management of isolation facilities have been published recently. The study presented was set up to compare the operational management, resources, and technical equipment among European isolation facilities. Due to differences in geography, population density, and national response plans it was hypothesized that adherence to recommendations will vary. Methods and Findings: Until mid of 2010 the European Network for Highly Infectious Diseases conducted a cross-sectional analysis of isolation facilities in Europe, recruiting 48 isolation facilities in 16 countries. Three checklists were disseminated, assessing 44 items and 148 specific questions. The median feedback rate for specific questions was 97.9% (n = 47/48) (range: n = 7/48 (14.6%) to n = 48/48 (100%). Although all facilities enrolled were nominated specialised facilities' serving countries or regions, their design, equipment and personnel management varied. Eighteen facilities fulfilled the definition of a High Level Isolation Unit'. In contrast, 24 facilities could not operate independently from their co-located hospital, and five could not ensure access to equipment essential for infection control. Data presented are not representative for the EU in general, as only 16/27 (59.3%) of all Member States agreed to participate. Another limitation of this study is the time elapsed between data collection and publication; e.g. in Germany one additional facility opened in the meantime. Conclusion: There are disparities both within and between European countries regarding the design and equipment of isolation facilities. With regard to the International Health Regulations, terminology, capacities and equipment should be standardised

Considering the role of cognitive control in expert performance

© 2014, Springer Science+Business Media Dordrecht. Dreyfus and Dreyfus’ (1986) influential phenomenological analysis of skill acquisition proposes that expert performance is guided by non-cognitive responses which are fast, effortless and apparently intuitive in nature. Although this model has been criticised (e.g., by Breivik Journal of Philosophy of Sport, 34, 116–134 2007, Journal of the Philosophy of Sport, 40, 85–106 2013; Eriksen 2010; Montero Inquiry:An interdisciplinary Journal of Philosophy, 53, 105–122 2010; Montero and Evans 2011) for over-emphasising the role that intuition plays in facilitating skilled performance, it does recognise that on occasions (e.g., when performance goes awry for some reason) a form of ‘detached deliberative rationality’ may be used by experts to improve their performance. However, Dreyfus and Dreyfus (1986) see no role for calculative problem solving or deliberation (i.e., drawing on rules or mental representations) when performance is going well. In the current paper, we draw on empirical evidence, insights from athletes, and phenomenological description to argue that ‘continuous improvement’ (i.e., the phenomenon whereby certain skilled performers appear to be capable of increasing their proficiency even though they are already experts; Toner and Moran 2014) among experts is mediated by cognitive (or executive) control in three distinct sporting situations (i.e., in training, during pre-performance routines, and while engaged in on-line skill execution). We conclude by arguing that Sutton et al. Journal of the British Society for Phenomenology, 42, 78–103 (2011) ‘applying intelligence to the reflexes’ (AIR) approach may help to elucidate the process by which expert performers achieve continuous improvement through analytical/mindful behaviour during training and competition

Comparison of Forward and Reverse Wingate Anaerobic Tests: A Brief Technical Note

BACKGROUND: The Wingate anaerobic test (WAT) is traditionally performed in the forward pedaling direction on a cycle ergometer. However, reverse (backward) pedaling during a WAT test may be a novel way to convey meaningful information related to performance and rehabilitation. This study compared peak power measurements between 30-second forward pedaling WAT (FWAT) with a 30-second reverse pedaling WAT (RWAT). METHODS: 10 male and 10 female participants (age 27.6 ± 7.31 yrs, mass 74.9 ± 21.3 kg and height 172.6 ± 10.9 cm) volunteered to participate. Participants performed one FWAT and one RWAT at 7.5% of body mass on a specially modified Monark cycle ergometer. Tests were separated 2 days of rest. Peak power output (PPO), mean power output (MPO), relative PPO (RPPO), relative MPO (RMPO), fatigue index (%FI), and rating of perceived exertion (RPE) were measured. RESULTS: The FWAT power measurements were all significantly greater (p \u3c 0.05) than RWAT power measurements except MPO (p \u3e 0.05); and that RPE was significantly greater (p \u3c 0.05) in FWAT than RWAT. Specifically, FWAT vs. RWAT (M ± SD) are as follows: PPO watts (w) = 731.7 ± 237.1 vs. 529.6 ± 192.2; RPPO w/kg = 10.2 ± 2.3 vs. 7.2 ± 1.6; MPO w = 510.2 ± 162.1 vs. 415.1 ± 146.2; RMPO w/kg = 7.3 ± 1.5 vs. 5.8 ± 1.3; %FI = 49.2 ± 8.7 vs. 37.4 ± 13.7; and RPE = 19.4 ± 1.1 vs. 15.8 ± 1.5. Gender did not impact the relative differences in these relationships. CONCLUSION: Practitioners and clinicians may use this information to begin to understand the power and perceived exertion relationships of forward versus reverse pedaling during a WAT; exercise prescription for rehabilitation and performance may benefit