New frontiers for evaluation in an era of market - oriented development Monday 20 – Wednesday 22 July 2015

Over the past few decades there have been dramatic shifts in the way in which middle income and low income countries have achieved economic growth and political and social change. These changes have been driven by new contexts, new actors and new ideas, in which market-oriented development have become increasingly prominent. Traditional divisions between international aid and private sector investment have begun to breakdown, with the emergence of new forms of social and environmentally responsible investments and modalities. Evaluation practice, shaped by a dominant public sector paradigm, has not kept pace. This raises important questions about the role of evaluation, both in understanding the impact of new activities on society, as well as in supporting democratic accountability to citizens. As part of the International Year of Evaluation 2015, this Wilton Park convened meeting gave evaluation professionals, development partners, and investors an open forum to review recent evaluation experience, debate evaluation governance issues, and probe the methodological questions brought about by the market-based revolution

A qualitative study on intersectional stigma and sexual health among women on opioid substitution treatment in England: Implications for research, policy and practice

RationaleWomen on opioid substitution treatment (WOST) are at high risk for sexually transmitted infections and blood-borne viruses (HIV, Hepatitis B and C). This heightened risk is rooted in social and health inequities. Experiencing stigma is considered to have an important role in maintaining these inequities and is a barrier to promoting sexual health.ObjectiveThe aims of this study were to examine (1) the experiences of stigma of WOST, and (2) how experiencing stigma may influence WOST' sexual health.MethodTwenty semi-structured interviews with WOST were conducted between October 2016 and April 2017 in South West England (UK). Data were analysed using Framework Analysis.ResultsWomen's narratives highlighted the intersection of stigma associated with distinct elements of women's identities: (1) female gender, (2) drug use, (3) transactional sex, (4) homelessness, and (5) sexual health status. Intersectionality theory and social identity theory are used to explain sexual health risks and disengagement from (sexual) health services among WOST. Intersectional stigma was related to a lack of female and male condom use and a lack of access to (sexual) health services.ConclusionThe approach taken goes beyond individualistic approaches of health promotion and provides suggestions to improve future research, policy and practice. It identifies stigma as a crucial element to address when promoting sexual health among WOST. Importantly, this study focuses on tackling social and health inequities and in doing so advocates for human and women's rights

Sexual health services in community pharmacy for women on opioid substitution treatment: a qualitative study

BACKGROUND: Women on opioid substitution treatment (WOST) are at heightened risk for the sexual transmission of sexually transmitted infections and blood-borne viruses. This study aimed to explore the opportunities to promote their sexual health in community pharmacies in UK. METHODS: Semi-structured interviews were conducted with 20 WOST and 14 community pharmacists (CPs). A focus group was run with three CPs. Participants were recruited in drug services and a service for sex workers (WOST), and in CP. Data collection took place between October 2016 and September 2017. Data were analyzed using Framework Analysis and directed Content Analysis. RESULTS: CPs could play a role in promoting sexual health among WOST. Sexual health screening, treatment and condom supply were suggested as potential ways of delivering pharmacy-based sexual health services. These services should be actively offered to WOST, delivered in a private space and free of cost. We identified several challenges to overcome in order to design and implement sexual health services for WOST in community pharmacies. CONCLUSIONS: This study highlights the potentially key role CPs can have promoting sexual health and addressing health inequities among WOST. Improvements in pharmacists' training are required in order to address stigma towards WOST, and promote trust and positive rapport. Structural changes are also needed to broaden the services available for this group of women and improve their access to healthcare.</p

Project ATTAIN: Advancing Trauma-Informed Care for Youth with Intellectual and Developmental Disabilities and/or Gender Diverse Youth

Children with Intellectual and Developmental Disabilities (IDD) and/or gender diversity are at higher risk of experiencing trauma. Provider knowledge is lacking; trauma, disability, and LGBTQ+ resources are often siloed; and few providers screen for trauma in this population. This paper describes the design, delivery, and initial evaluation of Project ATTAIN (Access to Trauma-informed Treatment and Assessment for Neurodivergent and/or Gender-expansive Youth). ATTAIN is an ongoing 5-year state-wide initiative aiming to assess readiness to engage in new roles and practices over time; provide state-wide training and consultation in trauma, disability, and LGBTQ+-informed practices; install screening and assessment of trauma exposure and PTSD and quality of life into IDD and gender service settings; and include people with lived experience. A readiness assessment identified pre-training gaps between role responsibilities and practice engagement across five professional sectors serving our target population (n=39) in LGBTQ+-, disability-, and trauma-informed practices. We learned that specific sectors would benefit from introductory training to increase buy-in and promote role expansion; others would benefit from advanced instruction and implementation support. So far, we have trained 966 unique providers in trauma-informed care and have seen changes in the attitudes or perspectives of participants. Participants were highly satisfied with our provided training and saw increased knowledge across training. We screened 49 people in an IDD service setting for PTSD and quality of life. Two people with lived experience are active members of our research team, participating in project planning, training delivery, and manuscript authorship. Individuals who work with IDD and/or gender-diverse youth would benefit from increased training to expand their knowledge on LGBTQ+-, disability-, and trauma-informed practices. In year three, we intend to continue outreach and evidence-informed training focused on the intersection of trauma, IDD, and gender diversity. Ongoing evaluation of our outreach, training, and screening efforts will continue to inform program activities

The Telehealth Skills, Training, and Implementation Project: An evaluation protocol

External stabilization is reported to improve reliability of hand held dynamometry, yet this has not been tested in burns. We aimed to assess the reliability of dynamometry using an external system of stabilization in people with moderate burn injury and explore construct validity of strength assessment using dynamometry. Participants were assessed on muscle and grip strength three times on each side. Assessment occurred three times per week for up to four weeks. Within session reliability was assessed using intraclass correlations calculated for within session data grouped prior to surgery, immediately after surgery and in the sub-acute phase of injury. Minimum detectable differences were also calculated. In the same timeframe categories, construct validity was explored using regression analysis incorporating burn severity and demographic characteristics. Thirty-eight participants with total burn surface area 5 – 40% were recruited. Reliability was determined to be clinically applicable for the assessment method (intraclass correlation coefficient \u3e0.75) at all phases after injury. Muscle strength was associated with sex and burn location during injury and wound healing. Burn size in the immediate period after surgery and age in the sub-acute phase of injury were also associated with muscle strength assessment results. Hand held dynamometry is a reliable assessment tool for evaluating within session muscle strength in the acute and sub-acute phase of injury in burns up to 40% total burn surface area. External stabilization may assist to eliminate reliability issues related to patient and assessor strength

Escape the welcome cliché

The University of Surrey Library and Learning Support Services (LLSS) recognised an increasing need to transform its welcome, induction and orientation activities for students. Past activities have entailed delivering information to students in ways which may have led to information overload and lack of engagement by students with library services. The LLSS have been exploring innovative ways to welcome students to university, moving away from didactic approaches. This paper presents one such innovation produced among a series of activities during 2017/18, an educational escape room, informed by the work of Walsh (2017). This activity invited students to solve a series of themed puzzles in the escape room, introducing them to library services and information literacy (IL) skills to support their studies. This report provides an account of the challenges and positive outcomes encountered in designing the escape room, with a view to sharing good learning and teaching practice

Partner-Drug Resistance and Population Substructuring of Artemisinin-Resistant Plasmodium falciparum in Cambodia

Plasmodium falciparum in western Cambodia has developed resistance to artemisinin and its partner drugs, causing frequent treatment failure. Understanding this evolution can inform the deployment of new therapies. We investigated the genetic architecture of 78 falciparum isolates using whole-genome sequencing, correlating results to in vivo and ex vivo drug resistance and exploring the relationship between population structure, demographic history, and partner drug resistance. Principle component analysis, network analysis and demographic inference identified a diverse central population with three clusters of clonally expanding parasite populations, each associated with specific K13 artemisinin resistance alleles and partner drug resistance profiles which were consistent with the sequential deployment of artemisinin combination therapies in the region. One cluster displayed ex vivo piperaquine resistance and mefloquine sensitivity with a high rate of in vivo failure of dihydroartemisinin-piperaquine. Another cluster displayed ex vivo mefloquine resistance and piperaquine sensitivity with high in vivo efficacy of dihydroartemisinin-piperaquine. The final cluster was clonal and displayed intermediate sensitivity to both drugs. Variations in recently described piperaquine resistance markers did not explain the difference in mean IC90 or clinical failures between the high and intermediate piperaquine resistance groups, suggesting additional loci may be involved in resistance. The results highlight an important role for partner drug resistance in shaping the P. falciparum genetic landscape in Southeast Asia and suggest that further work is needed to evaluate for other mutations that drive piperaquine resistance

Selective sweep suggests transcriptional regulation may underlie Plasmodium vivax resilience to malaria control measures in Cambodia

In Cambodia, where Plasmodium vivax and Plasmodium falciparum are coendemic and intense multimodal malaria-control interventions have reduced malaria incidence, P. vivax malaria has proven relatively resistant to such measures. We performed comparative genomic analyses of 150 P. vivax and P. falciparum isolates to determine whether different evolutionary strategies might underlie this species-specific resilience. Demographic modeling and tests of selection show that, in contrast to P. falciparum, P. vivax has experienced uninterrupted growth and positive selection at multiple loci encoding transcriptional regulators. In particular, a strong selective sweep involving an AP2 transcription factor suggests that P. vivax may use nuanced transcriptional approaches to population maintenance. Better understanding of P. vivax transcriptional regulation may lead to improved tools to achieve elimination