Modeling Policy and Agricultural Decisions in Afghanistan

Afghanistan is responsible for the majority of the world's supply of poppy crops, which are often used to produce illegal narcotics like heroin. This paper presents an agent-based model that simulates policy scenarios to characterize how the production of poppy can be dampened and replaced with licit crops over time. The model is initialized with spatial data, including transportation network and satellite-derived land use data. Parameters representing national subsidies, insurgent influence, and trafficking blockades are varied to represent different conditions that might encourage or discourage poppy agriculture. Our model shows that boundary-level interventions, such as targeted trafficking blockades at border locations, are critical in reducing the attractiveness of growing this illicit crop. The principle of least effort implies that interventions decrease to a minimal non-regressive point, leading to the prediction that increases in insurgency or other changes are likely to lead to worsening conditions, and improvements require substantial jumps in intervention resources.Comment: 16 pages, 5 figures; GeoJournal, 2012, 10.1007/s10708-012-9453-

How does virtual simulation impact on nursing students’ knowledge and self-efficacy for recognising and responding to deteriorating patients? A mixed methods study.

Background: Preparing undergraduate nursing students effectively for safe clinical practice continues to present significant challenges due to the impact of the Covid-19 pandemic, global nursing shortages, greater competition for quality clinical placements, and no guarantee that nursing students will have exposure to a deteriorating patient during their clinical placements. This is a concern because early warning signs of clinical deterioration are often not detected by nurses in a timely manner, and recognition and response to deteriorating patients is recognised globally as a major safety challenge (Haddeland et al., 2018). Aim: To explore the impact of using interactive virtual simulation case studies with facilitated debriefing (Eppich and Cheng, 2015) on nursing students’ knowledge and self-efficacy for recognising and responding to early signs of clinical deterioration in patients. Design & Methods: Mixed methods study with quasi-experimental pre/post design and focus groups. A convenience sample (n=88) final year undergraduate nursing students with half the sample at each sites randomly allocated to a treatment or control group. The treatment group received a virtual simulation intervention, debriefing, and participated in a focus group. Results: The treatment group had statistically significant higher levels of clinical self-efficacy from pre to post survey scores (65.34 and 80.12) compared to the control group (62.59 and 70.73) and significantly increased levels of knowledge in recognizing and responding to the deteriorating patient scores from pre to post survey (11.30 to 13.1) in comparison to the control group (10.33 and 9.92). Conclusions: study findings demonstrated the positive impact of a the virtual simulation intervention on knowledge and confidence of undergraduate nursing students from geographically diverse areas

Census politics in deeply divided societies

Population censuses in societies that are deeply divided along ethnic, religious or linguistic lines can be sensitive affairs – particularly where political settlements seek to maintain peace through the proportional sharing of power between groups. This brief sets out some key findings from a research project investigating the relationship between census politics and the design of political institutions in Bosnia and Herzegovina, Kenya, Lebanon and Northern Ireland

Antibody decay, T cell immunity and breakthrough infections following two SARS-CoV-2 vaccine doses in infliximab- and vedolizumab-treated patients

We report SARS-CoV-2 vaccine-induced immunity and risk of breakthrough infections in patients with inflammatory bowel disease treated with infliximab, a commonly used anti-TNF drug and those treated with vedolizumab, a gut-specific antibody targeting integrin a4b7 that does not impact systemic immunity. In infliximab-treated patients, the magnitude of anti-SARS-CoV2 antibodies was reduced 4-6-fold. One fifth of both infliximab- and vedolizumab-treated patients did not mount a T cell response. Antibody half-life was shorter in infliximab-treated patients. Breakthrough SARS-CoV-2 infections occurred more frequently in infliximab-treated patients and the risk was predicted by the level of antibody response after second vaccine dose. Overall, recipients of two doses of the BNT162b2 vaccine had higher anti-SARS-CoV-2 antibody concentrations, higher seroconversion rates, shorter antibody half-life and less breakthrough infections compared to ChAdOx1 nCoV-19 vaccine recipients. Irrespective of biologic treatment, higher, more sustained antibody levels were observed in patients with a history of SARS-CoV-2 infection prior to vaccination. Patients treated with anti-TNF therapy should be offered third vaccine doses

COVID-19 vaccine-induced antibody and T cell responses in immunosuppressed patients with inflammatory bowel disease after the third vaccine dose

Background: COVID-19 vaccine-induced antibody responses are reduced in patients with inflammatory bowel disease (IBD) taking infliximab or tofacitinib after two vaccine doses. We sought to determine whether immunosuppressive treatments were associated with reduced antibody and T cell responses after a third vaccine dose. Methods: 352 adults (72 healthy controls and 280 IBD) from the prospectively recruited study cohort were sampled 28-49 days after a third dose of SARS-CoV-2 vaccine. IBD medications studied included thiopurines (n=65), infliximab (n=46), thiopurine/infliximab combination therapy (n=49), ustekinumab (n=44), vedolizumab (n=50) or tofacitinib (n=26). SARS-CoV-2 spike antibody binding and T cell responses were measured. Findings: Geometric mean [geometric SD] anti-S1 RBD antibody concentrations increased in all study groups following a third dose of vaccine, but were significantly lower in patients treated with infliximab (2736.8 U/mL [4.3]; P<0.0001), infliximab and thiopurine combination (1818.3 U/mL [6.7]; P<0.0001) and tofacitinib (8071.5 U/mL [3.1]; P=0.0018) compared to controls (16774.2 U/ml [2.6]). There were no significant differences in anti-S1 RBD antibody concentrations between control subjects and thiopurine (12019.7 U/mL [2.2]; P=0.099), ustekinumab (11089.3 U/mL [2.8]; P=0.060), nor vedolizumab treated patients (13564.9 U/mL [2.4]; P=0.27). In multivariable modelling, lower anti-S1 RBD antibody concentrations were independently associated with infliximab (Geometric mean ratio 0.15, 95% CI 0.11-0.21, P<0.0001), tofacitinib (0.52, 95% CI 0.31-0.87, P=0.012) and thiopurine (0.69, 95% CI 0.51-0.95, P=0.021), but not with ustekinumab (0.64, 95% CI 0.39-1.06, P=0.083), or vedolizumab (0.84, 95% CI 0.54-1.30, P=0.43). Previous SARS-CoV-2 infection (1.58, 95% CI 1.22-2.05, P=0.00056) and older age (0.88, 95% CI 0.80-0.97, P=0.0073) were independently associated with higher and lower anti-S1 antibody concentrations respectively. However, antigen specific T cell responses were similar in IBD patients in all treatment groups studied, except for recipients of tofacitinib without evidence of previous infection, where T cell responses were significantly reduced relative to healthy controls (p=0.021). Interpretation: A third dose of COVID-19 vaccine induced a boost in antibody binding in immunosuppressed patients with IBD, but these responses were reduced in patients taking infliximab, infliximab/thiopurine combination and tofacitinib therapy. Tofacitinib was also associated with reduced T cell responses. These findings support continued prioritisation of immunosuppressed groups for further booster dosing, particularly those on Janus Kinase (JAK) inhibitors who have attenuation of both serological and cell-mediated vaccine-induced immunity. Funding: Financial support was provided as a Research Grant by Pfizer Ltd

A long view of liberal peace and its crisis

The ‘crisis’ of liberal peace has generated considerable debate in International Relations. However, analysis is inhibited by a shared set of spatial, cultural and temporal assumptions that rest on and reproduce a problematic separation between self-evident ‘liberal’ and ‘non-liberal’ worlds, and locates the crisis in presentist terms of the latter’s resistance to the former’s expansion. By contrast, this article argues that efforts to advance liberal rule have always been interwoven with processes of alternative order-making, and in this way are actively integral, not external, to the generation of the subjectivities, contestations, violence and rival social orders that are then apprehended as self-evident obstacles and threats to liberal peace and as characteristic of its periphery. Making visible these intimate relations of co-constitution elided by representations of liberal peace and its crisis requires a long view and an analytical frame that encompasses both liberalism and its others in the world. The argument is developed using a Foucauldian governmentality framework and illustrated with reference to Sri Lanka

Fieldwork after Conflict: Contextualising the Challenges of Access and Data Quality

Despite sustained scholarly interest in post‐conflict states, there has not been a thorough review and analysis of associated methodology and the challenges of conducting research in these contexts. Addressing this gap, this paper directs attention to the particular effects of these settings on access and data quality and their ramifications for the resulting scholarship. It assesses the intrinsic challenges of performing fieldwork in these environments, drawing on both relevant social science literature and the authors’ experiences of carrying out research in Afghanistan and Timor‐Leste. The study demonstrates that the post‐conflict environment moulds research design and, consequently, influences how questions are answered as well as the questions asked. Moreover, it highlights ways to mitigate these issues. This work is of relevance to scholars planning to engage in field research and to researchers reflecting upon their work, as well as to policymakers who are considering undertaking programmes or commissioning research in post‐conflict areas