Localisation in the context of UK government engagement with the humanitarian reform agenda

From Frontiers via Jisc Publications RouterAlastair Ager - ORCID: 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563Localisation is a key element of the humanitarian reform agenda. However, there are continuing debates regarding its form and emphasis, linked to understandings of the local, the role of the state and the implications for interpretation of humanitarian principles of “de-internationalised” humanitarian response. This paper considers UK engagement with the localisation agenda, particularly through examination of the policies and programmes of the Department for International Development (DFID). The UK was a major contributor to dialogue on localisation at the World Humanitarian Summit of 2016 and has subsequently shown strong support for Grand Bargain commitments and implementation of a larger proportion of programmes involving cash transfers. Overall, however, advance on this agenda has been limited. The paper notes three major areas of constraint. First, logistical concerns have frequently been noted, particularly with respect to tasks such as procurement and financial monitoring. This has limited the engagement of many local actors lacking organisational capacity in these areas. Second, conceptual ambiguity has also played a significant role. Localisation is poorly theorised, and the roles, functions and capacities—beyond procurement of supplies and emergency technical assistance—that local actors may be able to fulfil far more effectively than international ones are not frequently addressed. Narrowly framed understandings of principles such as independence and impartiality, for instance, appear to severely limit confidence in engaging with local religious actors. Third, political considerations appear to have increasingly limited the space for more radical interpretations of the implications of localisation. Successive UK Secretaries of State for International Development have defended the commitment to a fixed proportion of Gross National Income (GNI) for development assistance based on strong public support for UK aid expenditure to reflect national interests and values. In this context, there are few clear political incentives to cede power over decision-making regarding UK Overseas Development Assistance (ODA) to national and local actors in a manner required for fundamental localisation of humanitarian response. Even where there is a clear potential UK interest—for example, bolstering capacity of local actors in contexts vulnerable to humanitarian emergency to avert more costly emergency response—the public perception of capacity strengthening (compared to life-saving humanitarian actions) mitigates against such moves in a climate of contested public spending. The establishment of a merged Foreign Commonwealth and Development Office in 2020 signals the likelihood of a reframing of localisation. While some advancement in terms of some logistical and conceptual barriers may be anticipated, issues of both national interest and public perceptions of national interest seem likely to continue to constrain a more radical implementation of localisation, particularly with current suspension of the commitment to spend 0.7% of GNI on ODA.3pubpu

Development of a hot-melt extrusion (HME) process to produce drug loaded Affinisol™ 15LV filaments for Fused Filament Fabrication (FFF) 3D printing

The aim of the present work was to develop a pilot scale process to produce drug-loaded filaments for 3D printing of oral solid dose forms by fused filament fabrication (FFF). Using hot melt extrusion, a viable operating space and understanding of processing limits were established using a hydrophilic polymer (hydroxypropyl methylcellulose (HPMC) - Affinisol™ LV15). This was then extended to formulate paracetamol (PCM) loaded Affinisol™ 15LV filaments across a wide range of compositions (5 - 50 wt% drug). From the process development work, challenges in achieving a pilot scale process for filament production for pharmaceutical applications have been highlighted. 3D printing trials across the range of compositions demonstrated limitations concerning the ability to print successfully across all compositions. Results from characterisation techniques including thermal and mechanical testing when applied to the formulated filaments indicated that these techniques are a useful predictive measure for assessing the ability to print a given formulation via filament methods. Oral solid dosage forms of variable surface area to mass ratios printed from suitable filament compositions demonstrated the ability to modify the release rates of drug for fixed formulations across substantial timescales

Prediction of the radiative heat transfer in small and large scale oxy-coal furnaces

Predicting thermal radiation for oxy-coal combustion highlights the importance of the radiation models for the spectral properties of gases and particles. This study numerically investigates radiation behaviours in small and large scale furnaces through refined radiative property models, using the full-spectrum correlated k (FSCK) model and Mie theory based data, compared with the conventional use of the weighted sum of grey gases (WSGG) model and the constant values of the particle radiation properties. Both oxy-coal combustion and air-fired combustion have been investigated numerically and compared with combustion plant experimental data. Reasonable agreements are obtained between the predicted results and the measured data. Employing the refined radiative property models achieves closer predicted heat transfer properties to the measured data from both furnaces. The gas-phase component of the radiation energy source term obtained from the FSCK property model is higher within the flame region than the values obtained by using the conventional methods. The impact of using non-grey radiation behaviour of gases through the FSCK is enhanced in the large scale furnace as the predicted gas radiation source term is approximately 2-3 times that obtained when using the WSGG, while the same term is in much closer agreement between the FSCK and the WSGG for the pilot-scale furnace. The predicted total radiation source term (from both gases and particles) is lower in the flame region after using the refined models, which results in a hotter flame (approximately 50-150 K higher in this study) compared with results obtained from conventional methods. In addition, the predicted surface incident radiation reduces by using the refined radiative property models for both furnaces, in which the difference is relevant with the difference in the predicted radiation properties between the two modelling techniques. Numerical uncertainties resulting from the influences of combustion model, turbulent particle dispersion and turbulence modelling on the radiation behaviours are discussed

The Uses of Stance in Media Production: Embodied Sociolinguistics and Beyond

While many conversation analysts, and scholars in related fields, have used video-recordings to study interaction, this study is one of a small but growing number that investigates video-recordings of the joint activities of media professionals working with, and on, video. It examines practices of media production that are, in their involvement with the visual and verbal qualities of video, both beyond talk and deeply shaped by talk. The article draws upon video recordings of the making of a feature-length documentary. In particular, it analyses a complex course of action where an editing team are reviewing their interview of the subject of the documentary, their footage is being intercut with existing reality TV footage of that same interviewee. The central contributions that the article makes are, firstly, to the sociolinguistics of mediatisation, through the identification of the workplace concerns of the members of the editing team, secondly showing how editing is accomplished, moment-by-moment, through the use of particular forms of embodied action and, finally, how the media themselves feature in the ordering of action. While this is professional work it sheds light on the video-mediated practices in contemporary culture, especially those found in social media where video makers carefully consider their editing of the perspective toward themselves and others

A community-based geological reconstruction of Antarctic Ice Sheet deglaciation since the Last Glacial Maximum

A robust understanding of Antarctic Ice Sheet deglacial history since the Last Glacial Maximum is important in order to constrain ice sheet and glacial-isostatic adjustment models, and to explore the forcing mechanisms responsible for ice sheet retreat. Such understanding can be derived from a broad range of geological and glaciological datasets and recent decades have seen an upsurge in such data gathering around the continent and Sub-Antarctic islands. Here, we report a new synthesis of those datasets, based on an accompanying series of reviews of the geological data, organised by sector. We present a series of timeslice maps for 20ka, 15ka, 10ka and 5ka, including grounding line position and ice sheet thickness changes, along with a clear assessment of levels of confidence. The reconstruction shows that the Antarctic Ice sheet did not everywhere reach the continental shelf edge at its maximum, that initial retreat was asynchronous, and that the spatial pattern of deglaciation was highly variable, particularly on the inner shelf. The deglacial reconstruction is consistent with a moderate overall excess ice volume and with a relatively small Antarctic contribution to meltwater pulse 1a. We discuss key areas of uncertainty both around the continent and by time interval, and we highlight potential priorit. © 2014 The Authors

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Tumour genomic and microenvironmental heterogeneity as integrated predictors for prostate cancer recurrence: a retrospective study

Clinical prognostic groupings for localised prostate cancers are imprecise, with 30–50% of patients recurring after image-guided radiotherapy or radical prostatectomy. We aimed to test combined genomic and microenvironmental indices in prostate cancer to improve risk stratification and complement clinical prognostic factors