Dangerous diagnostics? Regulatory reform in the genomic era

Molecular diagnostics are expanding rapidly yet many have not been externally evaluated. Kelly Holloway and colleagues identify failings in the regulatory system and report on recent efforts at refor

Health Canada needs to act on laboratory-developed diagnostics

An international exposé of flawed regulations for medical implants prompted Canada’s health minister to announce sweeping changes to the regulation of medical devices.1 Yet an important subset of medical devices remains outside the purview of this regulatory overhaul: laboratory-developed tests

The importance of connected and interspersed urban green and blue space for biodiversity: A case study in Cork City, Ireland

Urban green and blue space (UGBS) is becoming increasingly important for supporting biodiversity, with the spatial configuration of these landscapes essential to supporting a range of taxa. The role of UGBS for supporting biodiversity is well established, but there remains a lack of consensus on the importance of the overall landscape configuration and the scale at which these configurations are analyzed. Moreover, statistical models are often compounded by coarse representations of UGBS that ignore ‘invisible’ spaces (i.e., gardens and brownfield sites). Using Sentinel-2 satellite data and a maximum likelihood classification, a comprehensive landcover map of Cork City, Ireland was produced with reliable accuracy. FRAGSTATS was then used to capture landscape metrics regarding the spatial configuration of the study area, at a city scale and at three spatial extents for each field site. Field surveys at 72 locations captured data on bird species richness and abundance, before generalized linear models (GLMs) were parameterized between biodiversity metrics and the landscape metrics at 50, 100, and 200 m scales. The UGBS classification revealed that two-thirds of the city is composed of green and blue space. The field surveys recorded 62 species in the city, while GLMs revealed that green space was a significant driver in increasing species richness and abundance, while blue space produced inversions in coefficient estimates, suggesting a more nuanced relationship. The edge effect phenomenon was suggested to play a key role in increasing bird diversity, with a diversified and varied urban landscape important. The impact of scale also affected how blue space was viewed as a connective network within the city, particularly in relation to biodiversity metrics. Overall, this study has demonstrated that UGBS is intrinsically linked to bird diversity. Moreover, 38% of the species recorded are listed as species of conservation concern in Ireland, highlighting how urban spaces can provide habitats for vulnerable species and should inform discussion on the role of geography within the implementation of conservation and planning initiatives for urban environs

Strengthening the role of the executive nurse director: a qualitative interview study

Aim: To explore the challenges and opportunities facing executive nurse directors in the UK and identify factors to strengthen their role and support more effective nurse leadership. Design: A qualitative descriptive study using reflexive thematic analysis. Methods: Semi‐structured, telephone interviews were carried out with 15 nurse directors and 9 nominated colleagues. Results: Participants described a uniquely complex role with a broader scope than any other executive board member. Seven themes were identified: preparation for the role, length of time in role, role expectations, managing complexity, status, being political and influencing. Strengthening factors included successful working relationships with other board colleagues, development of political skills and personal status, coaching and mentoring, working within a supportive team culture and having strong professional networks. Conclusion: Executive nurse leaders are key to the transmission of nursing values and the delivery of safety and quality in healthcare settings. To strengthen this role, the limiting factors and the recommended shared learning identified here should be recognized and addressed at an individual, organizational and professional level. Implications for the profession and patient care: Given the pressure on all health systems to retain nurses, the role of executive nurse leaders needs to be seen as an important source of professional leadership and their value in actioning health policy into practice recognized. Impact: New insights have been provided into the executive nurse director role across the UK. Findings have demonstrated challenges and opportunities to strengthen the executive nurse director role. These include recognition of the need for support, preparation, networking and more realistic expectations of this unique nursing role. Reporting method: The study adhered to the Consolidated Criteria for Reporting Qualitative Research. Patient or public contribution: There was no patient or public contribution

Half a Century of Wilson & Jungner: Reflections on the Governance of Population Screening.

Background: In their landmark report on the "Principles and Practice of Screening for Disease" (1968), Wilson and Jungner noted that the practice of screening is just as important for securing beneficial outcomes and avoiding harms as the formulation of principles. Many jurisdictions have since established various kinds of "screening governance organizations" to provide oversight of screening practice. Yet to date there has been relatively little reflection on the nature and organization of screening governance itself, or on how different governance arrangements affect the way screening is implemented and perceived and the balance of benefits and harms it delivers. Methods: An international expert policy workshop convened by Sturdy, Miller and Hogarth. Results: While effective governance is essential to promote beneficial screening practices and avoid attendant harms, screening governance organizations face enduring challenges. These challenges are social and ethical as much as technical. Evidence-based adjudication of the benefits and harms of population screening must take account of factors that inform the production and interpretation of evidence, including the divergent professional, financial and personal commitments of stakeholders. Similarly, when planning and overseeing organized screening programs, screening governance organizations must persuade or compel multiple stakeholders to work together to a common end. Screening governance organizations in different jurisdictions vary widely in how they are constituted, how they relate to other interested organizations and actors, and what powers and authority they wield. Yet we know little about how these differences affect the way screening is implemented, and with what consequences. Conclusions: Systematic research into how screening governance is organized in different jurisdictions would facilitate policy learning to address enduring challenges. Even without such research, informal exchange and sharing of experiences between screening governance organizations can deliver invaluable insights into the social as well as the technical aspects of governance

The Social Network: How People with Visual Impairment use Mobile Phones in Kibera, Kenya

Living in an informal settlement with a visual impairment can be very challenging resulting in social exclusion. Mobile phones have been shown to be hugely beneficial to people with sight loss in formal and high-income settings. However, little is known about whether these results hold true for people with visual impairment (VIPs) in informal settlements. We present the findings of a case study of mobile technology use by VIPs in Kibera, an informal settlement in Nairobi. We used contextual interviews, ethnographic observations and a co-design workshop to explore how VIPs use mobile phones in their daily lives, and how this use influences the social infrastructure of VIPs. Our findings suggest that mobile technology supports and shapes the creation of social infrastructure. However, this is only made possible through the existing support networks of the VIPs, which are mediated through four types of interaction: direct, supported, dependent and restricted