Implementation approaches for leprosy prevention with single-dose rifampicin: a support tool for decision making

BACKGROUND: In the past 15 years, the decline in annually detected leprosy patients has stagnated. To reduce the transmission of Mycobacterium leprae, the World Health Organization recommends single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients. Various approaches to administer SDR-PEP have been piloted. However, requirements and criteria to select the most suitable approach were missing. The aims of this study were to develop an evidence-informed decision tool to support leprosy programme managers in selecting an SDR-PEP implementation approach, and to assess its user-friendliness among stakeholders without SDR-PEP experience. METHODOLOGY: The development process comprised two phases. First, a draft tool was developed based on a literature review and semi-structured interviews with experts from various countries, organisations and institutes. This led to: an overview of existing SDR-PEP approaches and their characteristics; understanding the requirements and best circumstances for these approaches; and, identification of relevant criteria to select an approach. In the second phase the tool's usability and applicability was assessed, through interviews and a focus group discussion with intended, inexperienced users; leprosy programme managers and non-governmental organization (NGO) staff. PRINCIPAL FINDINGS: Five SDR-PEP implementation approaches were identified. The levels of endemicity and stigma, and the accessibility of an area were identified as most relevant criteria to select an approach. There was an information gap on cost-effectiveness, while successful implementation depends on availability of resources. Five basic requirements, irrespective of the approach, were identified: stakeholder support; availability of medication; compliant health system; trained health staff; and health education. Two added benefits of the tool were identified: its potential value for advocacy and for training. CONCLUSION: An evidence-informed SDR-PEP decision tool to support the selection of implementation approaches for leprosy prevention was developed. While the tool was evaluated by potential users, more research is needed to further improve the tool, especially health-economic studies, to ensure efficient and cost-effective implementation of SDR-PEP

Working with Complexity: a Participatory Systems-Based Process for Planning and Evaluating Rural Water, Sanitation and Hygiene Services

Individuals working within the water, sanitation and hygiene for development (WASH) sector grapple daily with complex technical, social, economic, and environmental issues that often produce unexpected outcomes that are difficult to plan for and resolve. Here we propose a method we are calling the ‘Participatory Systems-based Planning and Evaluation Process’ (PS-PEP) that combines structural factor analysis and collaborative modeling to guide teams of practitioners, researchers, and other stakeholders through a process of modeling and interpreting how factors systemically and dynamically influence sustained access to WASH services. The use and utility of the PS-PEP is demonstrated with a regional team of water committee members in the municipality of Jalapa, Nicaragua who participated in a two-day modeling workshop. Water committee members left the workshop with a clear set of action items for water service planning and management in Jalapa, informed by the analysis of systemic influences and dependencies between key service factors. In so doing, we find that the PS-PEP provides a powerful tool for WASH project or program planning, evaluation, management and policy, the continued use of which could offer unprecedented growth in understanding of WASH service complexity for a broad spectrum of service contexts

Leiter-R versus developmental quotient for estimating cognitive function in preschoolers with pervasive developmental disorders

The utility of the developmental quotient (DQ) obtained with the Psychoeducational Profile Revised (PEP-R) was assessed as a means of estimating cognitive ability in young children with pervasive developmental disorders. Data from the PEP-R were analysed in a sample of 44 children aged from 2.0 to 5.9 years (mean 3.46 ± 1), 13 with an autistic disorder and 31 with a pervasive developmental disorder not otherwise specified. DQ scores were compared with scores from the Leiter International Performance Scale Revised-Visualization and Reasoning Battery (Leiter-R) in the same 44 children. Overall and domain DQs on the PEP-R were significantly correlated with Leiter-R scores. This study suggests that DQ scores obtained from the PEP-R in preschool children with pervasive developmental disorders may be a viable alternative to the Leiter-R as an assessment tool

Nafamostat reduces the incidence of post-ERCP pancreatitis : a systematic review and meta-analysis of randomized controlled trials

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). As the management of pancreatitis is limited, clinical approaches focus on the prevention of post-ERCP pancreatitis (PEP). In theory, the serine protease inhibitor nafamostat can reduce circulating inflammatory mediators in pancreatitis. We aimed to investigate the effect of nafamostat in the prevention of PEP in this systematic review and meta-analysis. The protocol for this review was registered in PROSPERO (CRD42022367988). We systematically searched five databases without any filters on 26th September 2022. The eligible population was adult patients undergoing ERCP. We compared the PEP preventive effect of nafamostat to placebo. The main outcome was the occurrence of PEP. We calculated the pooled odds ratios (OR), mean differences (MD), and corresponding 95% confidence intervals (95%CI) and multilevel model. The risk of bias was assessed using the Rob2 tool. Seven randomized controlled trials involving 2,962 patients were eligible for inclusion. Nafamostat reduced the overall incidence rate of PEP [20 mg OR 0.50; 95%CI 0.30-0.82 and 50 mg 0.48; 95%CI 0.24-0.96]. However, the occurrence of mild PEP was significantly reduced only in the subgroup receiving 20 mg nafamostat [OR 0.49; 95%CI 0.31-0.77]. Overall, nafamostat therapy reduced moderate PEP in high-risk patients [OR 0.18; 95%CI 0.0.4-0.84] and mild PEP in low-risk patients [OR 0.32; 95%CI 0.17-0.61]. Nafamostat is an effective therapy in the prevention of mild post-ERCP pancreatitis. Further research is required to determine the cost-effectiveness of this therapy

The transcriptional apparatus of Chlamydomonas chloroplasts

The transcriptional apparatus of higher plant chloroplasts is well characterised and consists of a plastid-encoded polymerase (PEP) and a nuclear encoded polymerase (NEP). PEP is dispensable to cell viability. The situation in green algal species, however, is less clear. Chloroplast genes encoding subunits of the PEP have been cloned and sequenced in the green alga Chlamydomonas reinhardtii and preliminary reverse-genetic studies suggest that PEP is essential to cell viability, which is in contrast to the situation in higher plants. To investigate this further a series of gene knockouts were constructed using the chloroplast gene rpoC2, encoding the " subunit of PEP. Results indicate that PEP is essential to C. reinhardtii cell viability. In addition, inhibitors of PEP have been used in an in vivo transcription assay to try to identify a second RNA polymerase activity in C. reinhardtii chloroplasts. In all higher plant and red algal species so far studied the PEP factor is encoded in the nuclear genome. A C. reinhardtii nuclear gene (rpoD) encoding a putative PEP factor has been cloned and partially sequenced. This is the first factor cloned from a green algal species. A transcript of ~2.9 kb was detected for the rpoD gene by northern analysis. Finally, epitope tagging technology was developed for chloroplast and bacterial gene products. The rpoC2 gene of C. reinhardtii was modified to produce a 6x-histidine tagged polypeptide and an attempt was made to purify this polypeptide from C. reinhardtii cells using IMAC. In addition, a 3x haemagglutinin (HA) epitope tag was codon optimised for use in C. reinhardtii chloroplasts and this epitope was used to tag -galactosidase in E. coli. The protein was detected in a western blot using anti-HA monoclonal antibodies. This epitope will prove useful as a tool to tag C. reinhardtii chloroplast proteins

OT-PEP: Development of a Professional Education Paradigm for Occupational Therapy

This study aims to determine the fundamental tenets that define the occupational therapy education process, and to develop a professional education paradigm that corresponds to those principles. Interpretive phenomenology with Heideggerian hermeneutic philosophy was used to explicate the paradigmatic themes embedded in the occupational therapy body of knowledge. The results yielded the Occupational Therapy Professional Education Paradigm (OT-PEP), which is organized around three core concepts: Adaptive thinking, reflection, and creation of meaning. The OT-PEP is important to occupational therapy because it addresses the elements of the education process that are reflective of the philosophical underpinnings of the profession and brings together these understandings as a unified whole. Interpretive phenomenology asserts that analysis of data is influenced by the phenomenologist’s repertoire of experience. Therefore, the OT-PEP presented in the article can be considered a single offering from the author that has the potential to morph with additional analyses. The author is hopeful that occupational therapy education programs will discuss and debate the OT-PEP constructs and determine which elements are most valuable. In addition, novice educators could use the OT-PEP as a faculty development tool to assist with transitioning from clinical practice to academia