Passing on the Hot Potato: Lessons from a Policy Brief Experiment

Research has potential to improve the lives of the world's vulnerable people – if it is appropriately referred to in decision?making processes. While there is a significant industry of activity each year to communicate research findings, little systematic research has tested or compared the effectiveness of such efforts. One popular research communication tool is the policy brief. In this article we draw on findings from a recent study on how a policy brief works; concluding that a policy brief does not have a linear effect on its readers. Instead, a reader can take a number of alternative routes from belief to action, some of which could subvert the intended outcome of the policy brief in question. We reflect also on the question of what makes for an effective policy brief; concluding that policy briefs that give personality and form to the researcher behind the written word may invoke a deeper relationship between the reader and the author, and affect a greater inclination in the reader to share the message with someone else – that is, they pass the hot potato. 1 The study itself was a first of its kind and contributes to our understanding about the effectiveness of research communication, as well as how to evaluate research communication effectiveness

A sea of Lilliputians

Author Posting. © The Author(s), 2008. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Palaeogeography, Palaeoclimatology, Palaeoecology 284 (2009): 88-113, doi:10.1016/j.palaeo.2009.08.020.Smaller size is generally seen as a negative response of organisms to stressful environmental conditions, associated with low diversity and species dominance. The mean size of the coccolithophorids decreased through the Neogene, leading to the prediction that their extant representatives are characterized by poor diversification and low specialization. The study of the (exo)coccospheres of selected taxa in the order Syracosphaerales negates this prediction, revealing that on the contrary some extant lineages are highly diversified and remarkably specialized. Whereas the general role of coccoliths remains indeterminate, this analysis suggests that some highly derived coccoliths may be modified for the collection of food particles, including picoplankton, thus implying that mixotrophy may characterize these lineages. In the extant coccolithophorids, species richness of genera is inversely correlated with the size of cells, definitive evidence that small size is part of a morphologic strategy rather than a sign of evolutionary failure. Because of their extreme minuteness, the extant nannoplankton can be well compared to Lilliputians, but the trend toward size decrease in Neogene lineages is not attributable to the Lilliput effect described by Urbanek (1993)

Key Concepts for making informed Choices

Teach people to think critically about claims and comparisons — they will make better decisions

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

From plan to project : a case study of how climate change adaptation is implemented in two development projects in Oslo municipality

En effekt av klimaendringene i Norge er at nedbøren øker vesentlig, både i intensitet og hyppighet. Dette kombinert med en stadig fortetting av byer og tettsteder har ført til økte problemer med overvann. Konsekvensene dette fører med seg er allerede synlige etter større nedbørshendelser i dag, og om samfunnet ikke begynner å tilpasse seg vil problemene og skadene øke i omfang. Som en løsning på dette har åpne overvannsløsninger begynt å vokse frem, hvor stadig flere kommuner har begynt å stille krav til åpne og lokale overvannsløsninger i sine overordnede planer. Dette krever imidlertid et tverrfaglig samarbeid, og trekker en rekke nye profesjoner og etater inn i planleggingen. Samtidig gjøres hovedsakelig detaljplanleggingen og gjennomføringen av private aktører. På bakgrunn av dette undersøker oppgaven hvordan overordnede intensjoner om klimatilpasning blir implementert og oversatt videre i detaljreguleringsprosesser og prosjektutviklingen av nye utbyggingsprosjekter. Det undersøkes også hvordan planleggingen kan gi rammer for et godt samspill mellom de involverte aktørene og fagprofesjonene. Problemstillingen utforskes gjennom en casestudie av Oslo kommune og to nyere utbyggingsprosjekt i kommunen. Dette gjøres ved hjelp av dokumentstudier av reguleringsplanene, byggesaksprosessen og intervju. Funnene viser at Oslo kommune har kommet langt med å institusjonalisere klimatilpasning i sine planer og strategier. Utbyggingsprosjektene samsvarer med hvordan kommunen tolker og håndhever kravene. Kommunen har en forståelse for den stedlige konteksten som vanskeliggjør implementering helt etter kravene, ved at de prosjekterende skal redegjøre for at de har gjort så mye som mulig før man tyr til alternative løsninger i trinn 2 av 3- trinnsstrategien. Videre viser funnene at kravene kommunen stiller på et overordnet nivå er avgjørende for å sikre implementering videre i prosjektene. Funnene viser også at de prosjekterende kan få et større handlingsrom ved at det stilles mer spesifikke og tydelige krav, og at dette bidrar til å implementere nye åpne overvannsløsninger. Studien viser at utfordringene med implementering knytter seg til de stedlige forutsetningene på tomten, og at det først er i byggesaken kravene kommer til syne og blir tegnet ut. Til slutt kommer det fram at dette også krever en god samordning internt i kommunen, når kommunen skal bruke sin reguleringsmyndighet til å stille krav til de private aktørene.One of the effects of climate change in Norway is a significant increase in precipitation. These changes, combined with densification of cities lead to an increase in problems related to surface water runoff. The consequences of this are already visible after severe rainfalls today, and if society does not begin to adapt, the problems and the following damages will escalate. As a response to these challenges, open blue-green stormwater solutions have emerged. Municipalities have increasingly begun to set policies and regulations to implement these solutions in their municipal plans. However, implementation requires interdisciplinary collaboration which involves a number of new professions and municipal agencies in the planning process. At the same time, the detailed planning and actual implementation are mainly initiated by private developers. The aim of this thesis is to examine how intentions of climate change adaptation are implemented and translated into the detailed zoning process and the project development phase. Further, it investigates how planning can provide a good framework for collaboration between the involved actors and professionals. The research questions are explored through a case study of Oslo Municipality and two recent development projects, using a document study of the zoning plans, building permit process and interviews. The findings show that Oslo has institutionalized climate change adaptation regulations in its plans and strategies. The two development projects correspond along with how the Municipality interprets the regulations. The analysis shows that the Municipality has an understanding of the local context that makes it difficult to implement the policies, and requires the designers to show that they have done everything they can before it is applicable to use alternative stormwater solutions. Furthermore, it is clear that the requirements set by the municipality at an overall level are crucial in ensuring implementations in the projects. The findings also show that more specific provisions can give the designers an enlarged opportunity space and push the designers to implement new open stormwater solutions. The challenges of implementation are related to the site-specific conditions and that is first in the building permit process the provisions become evident. The results also show that implementation requires the municipality to maintain a certain level of coordination internally as they use their authority to set regulations for private developers.M-BYRE

Fra plan til prosjekt : en casestudie om hvordan klimatilpasning blir implementert i to utbyggingsprosjekt i Oslo kommune

En effekt av klimaendringene i Norge er at nedbøren øker vesentlig, både i intensitet og hyppighet. Dette kombinert med en stadig fortetting av byer og tettsteder har ført til økte problemer med overvann. Konsekvensene dette fører med seg er allerede synlige etter større nedbørshendelser i dag, og om samfunnet ikke begynner å tilpasse seg vil problemene og skadene øke i omfang. Som en løsning på dette har åpne overvannsløsninger begynt å vokse frem, hvor stadig flere kommuner har begynt å stille krav til åpne og lokale overvannsløsninger i sine overordnede planer. Dette krever imidlertid et tverrfaglig samarbeid, og trekker en rekke nye profesjoner og etater inn i planleggingen. Samtidig gjøres hovedsakelig detaljplanleggingen og gjennomføringen av private aktører. På bakgrunn av dette undersøker oppgaven hvordan overordnede intensjoner om klimatilpasning blir implementert og oversatt videre i detaljreguleringsprosesser og prosjektutviklingen av nye utbyggingsprosjekter. Det undersøkes også hvordan planleggingen kan gi rammer for et godt samspill mellom de involverte aktørene og fagprofesjonene. Problemstillingen utforskes gjennom en casestudie av Oslo kommune og to nyere utbyggingsprosjekt i kommunen. Dette gjøres ved hjelp av dokumentstudier av reguleringsplanene, byggesaksprosessen og intervju. Funnene viser at Oslo kommune har kommet langt med å institusjonalisere klimatilpasning i sine planer og strategier. Utbyggingsprosjektene samsvarer med hvordan kommunen tolker og håndhever kravene. Kommunen har en forståelse for den stedlige konteksten som vanskeliggjør implementering helt etter kravene, ved at de prosjekterende skal redegjøre for at de har gjort så mye som mulig før man tyr til alternative løsninger i trinn 2 av 3- trinnsstrategien. Videre viser funnene at kravene kommunen stiller på et overordnet nivå er avgjørende for å sikre implementering videre i prosjektene. Funnene viser også at de prosjekterende kan få et større handlingsrom ved at det stilles mer spesifikke og tydelige krav, og at dette bidrar til å implementere nye åpne overvannsløsninger. Studien viser at utfordringene med implementering knytter seg til de stedlige forutsetningene på tomten, og at det først er i byggesaken kravene kommer til syne og blir tegnet ut. Til slutt kommer det fram at dette også krever en god samordning internt i kommunen, når kommunen skal bruke sin reguleringsmyndighet til å stille krav til de private aktørene

The International Initiative for Impact Evaluation (3ie): an introduction

The International Initiative for Impact Evaluation (3ie) is a new organisation devoted to enhancing development effectiveness through supporting the production and use of evidence from rigorous impact studies. This paper outlines the theory of change that underlies 3ie's mission and the activities designed to address it.theory of change, Evaluation Gap Working Group, policy-relevant evidence, rigorous impact evaluation, development effectiveness, International Initiative for Impact Evaluation,