Maximising HIV prevention by balancing the opportunities of today with the promises of tomorrow: a modelling study

SummaryBackgroundMany ways of preventing HIV infection have been proposed and more are being developed. We sought to construct a strategic approach to HIV prevention that would use limited resources to achieve the greatest possible prevention impact through the use of interventions available today and in the coming years.MethodsWe developed a deterministic compartmental model of heterosexual HIV transmission in South Africa and formed assumptions about the costs and effects of a range of interventions, encompassing the further scale-up of existing interventions (promoting condom use, male circumcision, early antiretroviral therapy [ART] initiation for all [including increased HIV testing and counselling activities], and oral pre-exposure prophylaxis [PrEP]), the introduction of new interventions in the medium term (offering intravaginal rings, long-acting injectable antiretroviral drugs) and long term (vaccine, broadly neutralising antibodies [bNAbs]). We examined how available resources could be allocated across these interventions to achieve maximum impact, and assessed how this would be affected by the failure of the interventions to be developed or scaled up.FindingsIf all interventions are available, the optimum mix would place great emphasis on the following: scale-up of male circumcision and early ART initiation with outreach testing, as these are available immediately and assumed to be low cost and highly efficacious; intravaginal rings targeted to sex workers; and vaccines, as these can achieve a large effect if scaled up even if imperfectly efficacious. The optimum mix would rely less on longer term developments, such as long-acting antiretroviral drugs and bNAbs, unless the costs of these reduced. However, if impossible to scale up existing interventions to the extent assumed, emphasis on oral PrEP, intravaginal rings, and long-acting antiretroviral drugs would increase. The long-term effect on the epidemic is most affected by scale-up of existing interventions and the successful development of a vaccine.InterpretationWith current information, a strategic approach in which limited resources are used to maximise prevention impact would focus on strengthening the scale-up of existing interventions, while pursuing a workable vaccine and developing other approaches that can be used if further scale-up of existing interventions is limited.FundingBill & Melinda Gates Foundation

Shifting markers of identity in East London's diasporic religious spaces

This article discusses the historical and geographical contexts of diasporic religious buildings in East London, revealing – contrary both to conventional narratives of immigrant integration, mobility, and succession and to identitarian understandings of belonging – that in such spaces and in the concrete devotional practices enacted in them, markers and boundaries of identity (ritual, spatial, and political) are contested, renegotiated, erased, and rewritten. It draws on a series of case-studies: Fieldgate Street Synagogue in its interrelationship with the East London Mosque; St Antony's Catholic Church in Forest Gate where Hindus and Christians worship together; and the intertwined histories of Methodism and Anglicanism in Bow Road. Exploration of the intersections between ethnicity, religiosity, and class illuminates the ambiguity and instability of identity-formation and expression within East London's diasporic faith spaces

Meta-evaluation of a whole systems programme, ActEarly: a study protocol

INTRODUCTION: Living in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (>20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme's impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making. METHODS: The ActEarly meta-evaluation will follow and adapt the five iterative stages of the 'Evaluation of Programmes in Complex Adaptive Systems' (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model ("LifeSim") will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly's dynamic programme outputs at different system levels and measure the programme's system changes on early life health and well-being. DISCUSSION: This meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose

Meta-evaluation of a whole systems programme, ActEarly: A study protocol

Introduction: Living in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (>20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme’s impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making./ Methods: The ActEarly meta-evaluation will follow and adapt the five iterative stages of the ‘Evaluation of Programmes in Complex Adaptive Systems’ (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model (“LifeSim”) will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly’s dynamic programme outputs at different system levels and measure the programme’s system changes on early life health and well-being./ Discussion: This meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose

Improving policy efficiency and effectiveness to save more species: A case study of the megadiverse country Australia

Native flora and fauna species continue to decline in the megadiverse, wealthy, economically and politically stable nation of Australia despite current efforts in policy and management. Ongoing research is examining these declines, their causes and the adequacy of current policy, but strategies for improving the outcomes for threatened species have attracted less attention. We discuss several key aspects of Australia's national threatened species management approach that potentially hinder the efficiency and effectiveness of management: the threatened species listing process is lengthy and biased; recovery plan development is resource intensive, restricted to a subset of species and often not effective; funding for threatened species management is not allocated efficiently or transparently; and management is not designed to incorporate uncertainties and adapt to changing future threats. Based on these issues we recommend four changes to current process: rationalize listing and assessment processes; develop approaches to prioritize species-based and threat-based responses cost-effectively; estimate funds required to recover species and secure longer term funding; and accommodate uncertainties and new threats into the current planning framework. Cost-effective prioritization for species and threats identifies which actions are likely to achieve the greatest benefits to species per unit cost, thereby managing more species and threats with available funds. These improvements can be made without legislative reform, additional funding or socio-economic shifts. If implemented, we believe more Australian threatened species will benefit from current efforts. Many of the challenges facing Australia are analogous to issues in other countries including the United States, Canada and the United Kingdom and these recommendations could assist in improving threatened species management. (C) 2014 Elsevier Ltd. All rights reserved

Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline.

This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes

Towards net zero in agriculture: future challenges and opportunities for arable, livestock and protected cropping systems in the UK

© The AuthorsThe agricultural sector faces multiple challenges linked to increased climate uncertainty, causing severe shocks including increased frequency of extreme weather events, new pest and disease risks, soil degradation, and pre and postharvest food losses. This situation is further exacerbated by geopolitical instability and volatility in energy prices impacting on fertiliser supplies and production costs. Net zero strategies are vital to achieve both food security and address negative environmental impacts. This perspective paper reviews and assesses the most viable options (actions) to achieve net zero with a focus on the arable/livestock and protected cropping sectors in the UK. The methodology was based on a synthesis of relevant literature, coupled with expert opinions using the holistic PESTLE (Political, Environmental, Social, Technological, Legal and Environmental) approach to categorise actions, leading to formulation of a roadmap to achieve net zero. The PESTLE analysis indicated that there are technically and economically viable actions available which need to be prioritised depending on the ease of their implementation within the two crop sectors investigated. These actions include (i) policy changes that are better aligned to net zero; (ii) circular economy approaches; (iii) connectivity and accessibility of information; (iv) increased resilience to shocks; (v) changing diets, nutrition and lifestyles; (vi) target setting and attainment; and (vii) farm economics and livelihoods. The outputs can be used by stakeholders and decision makers to inform policy and drive meaningful changes in global food and environmental security

ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing.

Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the 'biomedical model' which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on 'downstream' interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing

How moving home influences appliance ownership: a Passivhaus case study

Low carbon dwellings shift the focus to electricity consumption and appliances by significantly lowering space heating energy consumption. Using a UK Passivhaus (low carbon) case study, interviews and pre/post-move-in appliance audits were employed to investigate how moving home can change the appliance requirements of appliance-using practices. Changes in appliance ownership were due to differences in how appliance-using practices (e.g. cooking, laundering, homemaking) were being performed. Existing/new appliances complemented/conflicted with a new home on the basis of whether the social meanings of specific appliance-using practices (e.g. stylishness, convenience, thermal comfort, cleanliness) could be met. This was evident, when moving home more generally, by households buying new modern appliances and managing spatial constraints. More specifically, regarding Passivhaus, hosting and homemaking practices were performed in ways that met thermal comfort expectations, in addition to appliance purchasing also being influenced by a fear that the Passivhaus technologies could fail. Whilst skills and competences were needed to perform appliance-using practices, these were less prominent in influencing appliance ownership changes. Conclusions include reflections on how the elements of appliance-using practices change when moving home, as well as what adhering to building standards could mean for the standardisation of appliance-using practices and domestic life more generally