The effectiveness of community engagement and participation approaches in low and middle income countries: contextualisation of review findings to South Asia and Nepal

Community engagement and participation approaches in South Asia and Nepal could be successful in the area of maternal and child health. Policy options should focus on appropriate incentives for volunteers; and local geographical, social, and cultural norms should be taken into account when engaging government, NGOs and the public

Running a successful network to support methodologists and guideline developers: sharing experiences from UK evidence synthesis networks

Running a successful network to support methodologists and guideline developers: sharing experiences from UK evidence synthesis networks Facilitators: Judith Thornton (NICE); Ruaraidh Hill (University of Liverpool), Emma McFarlane (NICE), Li Chia Chen (University of Manchester) BACKGROUND AND INTRODUCTION We established the ‘North West Evidence Synthesis Network’ (NWESN) to bring together guideline developers, health researchers and policy makers from across our region in order to share knowledge and expertise and raise awareness of methodological developments. Several other UK networks have been initiated including the ‘Liverpool Evidence Synthesis Network’ (LivEN). Feedback from members has been positive with both personal and institutional benefits. Other networks include: • Health Research Methodology and Implementation (HeRMI) • Bangor Evidence Synthesis Hub (BESH) • Peninsula Systematic Review discussion group (PenSR) OBJECTIVES • To advocate the role of networks • To discuss the practicalities to establishing/running networks • To explore what guideline developers needs from networks DESCRIPTION OF THE WORKSHOP Short presentations to compare and contrast the remit, structure and function of different networks. Group discussions to explore: • What guideline developers want from networks • Challenges to establishing/running networks and strategies to overcome these. • Future directions for networking • How networks can be better connected Group feedback and conclusions TARGET GROUPS All staff involved in evidence synthesis and guideline development. IMPLICATIONS FOR GUIDELINE DEVELOPERS Our presentation at the Global Evidence Summit 2017 demonstrated the benefits of membership of the NWESN. Implications for guideline developers included general education and updating on new methods; a key benefit is the opportunity to share skills, information and support across researchers and institutions. CONCLUSIONS The workshop intends to raise awareness of the benefits of networks and what they can offer methodologists and guideline developers. We hope to encourage more people to connect with and establish methodological networks

Estimating δ15N fractionation and adjusting the lipid correction equation using Southern African freshwater fishes

Stable isotope analysis is an important tool for characterising food web structure; however, interpretation of isotope data can often be flawed. For instance, lipid normalisation and trophic fractionation values are often assumed to be constant, but can vary considerably between ecosystems, species and tissues. Here, previously determined lipid normalisation equations and trophic fractionation values were re-evaluated using freshwater fish species from three rivers in the Upper Zambezian floodplain ecoregion in southern Africa. The parameters commonly used in lipid normalisation equations were not correct for the 18 model species (new D and I parameters were estimated as D = 4.46‰ [95% CI: 2.62, 4.85] and constant I = 0 [95% CI: 0, 0.17]). We suggest that future isotopic analyses on freshwater fishes use our new values if the species under consideration do not have a high lipid content in their white muscle tissue. Nitrogen fractionation values varied between species and river basin; however, the average value closely matched that calculated in previous studies on other species (δ15N fractionation factor of 3.37 ± 1.30 ‰). Here we have highlighted the need to treat stable isotope data correctly in food web studies to avoid misinterpretation of the data

A qualitative exploration of mental health services provided in community pharmacies.

The burden of mental health problems continues to grow worldwide. Community pharmacists', as part of the primary care team, optimise care for people living with mental illness. This study aims to examine the factors that support or hinder the delivery of mental health services delivered in Australian community pharmacies and proposes ideas for improvement. A qualitative study was conducted comprising focus groups with community pharmacists and pharmacy staff across metropolitan, regional, and rural areas of New South Wales, Australia. Data were collected in eight focus groups between December 2020 and June 2021. Qualitative data were analysed using thematic analysis. Thirty-three community pharmacists and pharmacy staff participated in an initial round of focus groups. Eleven community pharmacists and pharmacy staff participated in a second round of focus groups. Twenty-four factors that enable or hinder the delivery of mental health services in community pharmacy were identified. Participant's perception of a lack of recognition and integration of community pharmacy within primary care were identified as major barriers, in addition to consumers' stigma and lack of awareness regarding service offering. Suggestions for improvement to mental health care delivery in community pharmacy included standardised practice through the use of protocols, remuneration and public awareness. A framework detailing the factors moderating pharmacists, pharmacy staff and consumers' empowerment in mental health care delivery in community pharmacy is proposed. This study has highlighted that policy and funding support for mental health services is needed that complement and expand integrated models, promote access to services led by or are conducted in collaboration with pharmacists and recognise the professional contribution and competencies of community pharmacists in mental health care. The framework proposed may be a step to strengthening mental health support delivered in community pharmacies

Causality and the Interpretation of Epidemiologic Evidence

There is an ongoing debate regarding how and when an agent’s or determinant’s impact can be interpreted as causation with respect to some target disease. The so-called criteria of causation, originating from the seminal work of Sir Austin Bradford Hill and Mervyn Susser, are often schematically applied disregarding the fact that they were meant neither as criteria nor as a checklist for attributing to a hazard the potential of disease causation. Furthermore, there is a tendency to misinterpret the lack of evidence for causation as evidence for lack of a causal relation. There are no criteria in the strict sense for the assessment of evidence concerning an agent’s or determinant’s propensity to cause a disease, nor are there criteria to dismiss the notion of causation. Rather, there is a discursive process of conjecture and refutation. In this commentary, I propose a dialogue approach for the assessment of an agent or determinant. Starting from epidemiologic evidence, four issues need to be addressed: temporal relation, association, environmental equivalence, and population equivalence. If there are no valid counterarguments, a factor is attributed the potential of disease causation. More often than not, there will be insufficient evidence from epidemiologic studies. In these cases, other evidence can be used instead that increases or decreases confidence in a factor being causally related to a disease. Even though every verdict of causation is provisional, action must not be postponed until better evidence is available if our present knowledge appears to demand immediate measures for health protection

Molecular Model of Dynamic Social Network Based on E-mail communication

In this work we consider an application of physically inspired sociodynamical model to the modelling of the evolution of email-based social network. Contrary to the standard approach of sociodynamics, which assumes expressing of system dynamics with heuristically defined simple rules, we postulate the inference of these rules from the real data and their application within a dynamic molecular model. We present how to embed the n-dimensional social space in Euclidean one. Then, inspired by the Lennard-Jones potential, we define a data-driven social potential function and apply the resultant force to a real e-mail communication network in a course of a molecular simulation, with network nodes taking on the role of interacting particles. We discuss all steps of the modelling process, from data preparation, through embedding and the molecular simulation itself, to transformation from the embedding space back to a graph structure. The conclusions, drawn from examining the resultant networks in stable, minimum-energy states, emphasize the role of the embedding process projecting the non–metric social graph into the Euclidean space, the significance of the unavoidable loss of information connected with this procedure and the resultant preservation of global rather than local properties of the initial network. We also argue applicability of our method to some classes of problems, while also signalling the areas which require further research in order to expand this applicability domain

Topic refinement for Cochrane Reviews- working with partners to reach stakeholders

Topic refinement for Cochrane Reviews – working with partners to reach stakeholders: a case study Background This presentation describes a case study in Epilepsy and Movement Disorders review topic refinement - a process combining prioritisation of topics and the outcomes used to explore those topics. Agreeing topics for and relative importance of systematic reviews is an important part of the review production cycle. Difficult decisions sometimes need to be made as capacity in limited and there will competing ideas for reviews. Stakeholder engagement in topic refinement is just one aspect of the review process that needs careful thought and planning, not only in terms of methods, but also consideration of scope of the refinement and resources to be applied We will describe how we conducted stakeholder engagement that helped to refine, select and understand the importance of a selection of systematic reviews in epilepsy and Parkinson’s Disease. This topic refinement was part of a programme of work funded by NIHR (16/114/26). What we did When we refer to stakeholders in this project, we mean people with direct experience of the health conditions, such as people with epilepsy or Parkinson’s Disease, carers and health professionals. We engaged with stakeholders to seek their preferences for Cochrane systematic review topics relating to interventions and care for people with Epilepsy or Parkinson’s Disease. We used a shortlist of review topics developed by the review group editorial base in consultation with clinical experts. There were 26 shortlisted topics on epilepsy and 11 for Parkinson’s Disease. We used 2 separate web-based questionnaires for the topic refinement. People were asked to choose their top 5 review topics from the shortlists, rank these in order of priority and, finally, to comment on the reasons for their choices using free text boxes. A distinct feature of our approach was that the same questionnaire also invited people to suggest additional topics, rank these and share reasons for their suggestions. How we did it We carefully considered our approach to topic refinement, referring to approaches described by Cochrane Priority Setting Methods Group, James Lind Alliance (JLA), NICE and the REPRISE checklist and available digital technologies. We also developed partnerships with 2 key stakeholder groups representing people with Epilepsy or Parkinson’s Disease (Epilepsy Action, Parkinson’s UK). As a team, we agreed to focus our approach on the use of web-based questionnaires, promoted by our 2 partner groups and targeted social media activity. We focussed primarily on people living with either epilepsy or Parkinson’s, carers and family members, but health and social care professionals could also complete the survey. We used email from our stakeholder partners to their membership and social media to publicise the surveys and encourage participation. We also used a variety of visual media to catch people’s attention and direct them to the surveys. We ensured that the survey had links to infographics and materials (Cochrane and others) that explained the context for the survey was to informed priorities for Cochrane Systematic Reviews. Ethical approval was obtained from the University of Liverpool (Health and Life Sciences Research Ethics Committee 3087). What has been the output/impact? Overall response rates were excellent, and comparable numbers achieved for established organisations focusing on priorities (such as JLA). For the Epilepsy survey there were 569 survey participants and for the Parkinson’s survey, 470 people took part. For epilepsy ,336 people answered the question ‘Tell us more about why these topics are a priority for more research using a systematic review’. Responses ranged from descriptions of adverse effects of treatments, comments on the balance of control of conditions and adverse effects and uncertainties on effectiveness in particular groups. In the Parkinson’s survey, 272 people responded yielding a similarly rich source of data about choices. These are being analysed. What can others learn? • Options available to conduct topic refinement (prioritisation) at a good quality and scale within limited resources. • Practical advice on how to conduct successful online engagement for priority setting reviews, from a case study with people with Epilepsy or Parkinson’s Disease and their carers and family members. • Ways this exercise is contributing to Review Group discussions about topic choices and key areas to explore within their reviews

Calreticulin is a secreted BMP antagonist, expressed in Hensen's node during neural induction

Hensen's node is the “organizer” of the avian and mammalian early embryo. It has many functions, including neural induction and patterning of the ectoderm and mesoderm. Some of the signals responsible for these activities are known but these do not explain the full complexity of organizer activity. Here we undertake a functional screen to discover new secreted factors expressed by the node at this time of development. Using a Signal Sequence Trap in yeast, we identify several candidates. Here we focus on Calreticulin. We show that in addition to its known functions in intracellular Calcium regulation and protein folding, Calreticulin is secreted, it can bind to BMP4 and act as a BMP antagonist in vivo and in vitro. Calreticulin is not sufficient to account for all organizer functions but may contribute to the complexity of its activity

The effectiveness of community engagement and participation approaches in low and middle income countries: contextualisation of review findings to South Asia and Nepal

Community engagement and participation approaches in South Asia and Nepal could be successful in the area of maternal and child health. Policy options should focus on appropriate incentives for volunteers; and local geographical, social, and cultural norms should be taken into account when engaging government, NGOs and the public