Embedded geographies and quality construction in Sulawesi coffee commodity chains

Changing global conditions of agri-food production, trade and consumption are resulting in industry re-regulation and new forms of supply chain governance. This thesis explores emerging governance structures within a set of coffee commodity chains, which are dominated by various quality considerations. The research scrutinises relationships between the geographies of production and global commodity chain structures. To this end, a detailed investigation of production geographies is performed in one particular producing region, South Sulawesi in Indonesia. The diverse ways in which these regional geographies are inserted within, and transformed by, global supply chains in the coffee sector provide vital insights into emerging characteristics of the global economy. Prices paid for tropical commodities such as coffee, are currently at historic lows due primarily to chronic global oversupply. Quality-related product differentiation is a common policy recommendation to producers of tropical commodities to escape these depressed prices. In the Sulawesi coffee commodity chains moreover, quality is widely perceived and presented to consumers as a function of geographical associations with the site of agricultural production. However, a key insight of this thesis is to add a cautionary note to an argument for product differentiation as an unqualified economic development option for commodity producers. In the case of Sulawesi coffee, powerful corporate actors have been able to appropriate the value of geographically-informed quality differentiation. A central concern of this analysis is to document and interrogate the complex and contested (social) constructions of quality within the supply chains that link together disparate worlds of production and consumption. Traceability emerges as a critical mode of supply chain coordination to enable the authentication of quality constructions. Furthermore, traceability prioritises the accurate and efficient transmission of information and knowledge in the maintenance of trade relationships between supply chain actors. Traceability imperatives require innovative forms of supply chain coordination, and this thesis examines the emergence of new industry structures as a result of these changing conditions. Furthermore, the implementation of traceability systems with control over quality construction and management has important consequences for the allocation of economic benefits amongst supply chain actors

Identifying the science and technology dimensions of emerging public policy issues through horizon scanning

Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security.Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security

Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial.

BACKGROUND: Myeloma causes profound immunodeficiency and recurrent, serious infections. Around 5500 new cases of myeloma are diagnosed per year in the UK, and a quarter of patients will have a serious infection within 3 months of diagnosis. We aimed to assess whether patients newly diagnosed with myeloma benefit from antibiotic prophylaxis to prevent infection, and to investigate the effect on antibiotic-resistant organism carriage and health care-associated infections in patients with newly diagnosed myeloma. METHODS: TEAMM was a prospective, multicentre, double-blind, placebo-controlled randomised trial in patients aged 21 years and older with newly diagnosed myeloma in 93 UK hospitals. All enrolled patients were within 14 days of starting active myeloma treatment. We randomly assigned patients (1:1) to levofloxacin or placebo with a computerised minimisation algorithm. Allocation was stratified by centre, estimated glomerular filtration rate, and intention to proceed to high-dose chemotherapy with autologous stem cell transplantation. All investigators, patients, laboratory, and trial co-ordination staff were masked to the treatment allocation. Patients were given 500 mg of levofloxacin (two 250 mg tablets), orally once daily for 12 weeks, or placebo tablets (two tablets, orally once daily for 12 weeks), with dose reduction according to estimated glomerular filtration rate every 4 weeks. Follow-up visits occurred every 4 weeks up to week 16, and at 1 year. The primary outcome was time to first febrile episode or death from all causes within the first 12 weeks of trial treatment. All randomised patients were included in an intention-to-treat analysis of the primary endpoint. This study is registered with the ISRCTN registry, number ISRCTN51731976, and the EU Clinical Trials Register, number 2011-000366-35. FINDINGS: Between Aug 15, 2012, and April 29, 2016, we enrolled and randomly assigned 977 patients to receive levofloxacin prophylaxis (489 patients) or placebo (488 patients). Median follow-up was 12 months (IQR 8-13). 95 (19%) first febrile episodes or deaths occurred in 489 patients in the levofloxacin group versus 134 (27%) in 488 patients in the placebo group (hazard ratio 0·66, 95% CI 0·51-0·86; p=0·0018. 597 serious adverse events were reported up to 16 weeks from the start of trial treatment (308 [52%] of which were in the levofloxacin group and 289 [48%] of which were in the placebo group). Serious adverse events were similar between the two groups except for five episodes (1%) of mostly reversible tendonitis in the levofloxacin group. INTERPRETATION: Addition of prophylactic levofloxacin to active myeloma treatment during the first 12 weeks of therapy significantly reduced febrile episodes and deaths compared with placebo without increasing health care-associated infections. These results suggest that prophylactic levofloxacin could be used for patients with newly diagnosed myeloma undergoing anti-myeloma therapy. FUNDING: UK National Institute for Health Research

COVID-19 in hematology patients: real world experience in hospitals in the UK West Midlands

© 2021 The Authors. Published by Hilaris. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: [DOI/weblink]Objectives: This study aimed to understand the consequences of coronavirus disease 2019 (COVID-19) in patients diagnosed with haematological conditions, malignant and non-malignant. Method: A detailed insight into the first 112 patients with comorbidity of haematological conditions and COVID-19, admitted into nine National Health Services Trusts in the West Midlands Area of the United Kingdom, between 1st of March 2020 and 31st May 2020. Results: In the study cohort, 82% of patients had a malignant haematological disorder whilst 18% had a non-malignant haematological condition. Increasing age, breathlessness, reduction in oxygen saturation under 90% and abnormal chest x-ray were independently associated with higher mortality. Other long term co-morbidities did not present adverse impacts in this population. Survival analysis demonstrated that the COVID-19 severity score had a significant adverse correlation on patient outcome. COVID-19 patients who were classified as low risk, based on their primary haematological condition, showed significantly shorter survival time than those in the high risk category, which might be due to the shielding strategy for high infection risk patients. Conclusion: The 55% overall mortality in this cohort suggests that patients with haematological conditions had a higher mortality rate than patients with other acute, chronic or long term conditions. Significance: Previous studies have suggested poor outcomes for COVID‐19 infection in patients with haematological cancers, with short‐term mortality rates ranging from 32% to 62%. We report here the outcome of COVID-19 infection in patients with haematological conditions with both malignant and non-malignant, admitted to secondary care in acute care hospitals of the UK West Midlands. This study also examined the impact of chemo immunotherapy on outcomes from COVID-19 infection. This will be useful information to guide decision making during this second UK national lockdow

COVID-19 in haematology patients: A multi-centre West Midlands clinical outcomes analysis on behalf of West Midlands Research Consortium

This is an accepted manuscript of an article published by Wiley in British Journal of Haematology, available online on 05/11/2020 at: https://doi.org/10.1111/bjh.17136 The accepted version of the publication may differ from the final published version

Global Pyrogeography: the Current and Future Distribution of Wildfire

Climate change is expected to alter the geographic distribution of wildfire, a complex abiotic process that responds to a variety of spatial and environmental gradients. How future climate change may alter global wildfire activity, however, is still largely unknown. As a first step to quantifying potential change in global wildfire, we present a multivariate quantification of environmental drivers for the observed, current distribution of vegetation fires using statistical models of the relationship between fire activity and resources to burn, climate conditions, human influence, and lightning flash rates at a coarse spatiotemporal resolution (100 km, over one decade). We then demonstrate how these statistical models can be used to project future changes in global fire patterns, highlighting regional hotspots of change in fire probabilities under future climate conditions as simulated by a global climate model. Based on current conditions, our results illustrate how the availability of resources to burn and climate conditions conducive to combustion jointly determine why some parts of the world are fire-prone and others are fire-free. In contrast to any expectation that global warming should necessarily result in more fire, we find that regional increases in fire probabilities may be counter-balanced by decreases at other locations, due to the interplay of temperature and precipitation variables. Despite this net balance, our models predict substantial invasion and retreat of fire across large portions of the globe. These changes could have important effects on terrestrial ecosystems since alteration in fire activity may occur quite rapidly, generating ever more complex environmental challenges for species dispersing and adjusting to new climate conditions. Our findings highlight the potential for widespread impacts of climate change on wildfire, suggesting severely altered fire regimes and the need for more explicit inclusion of fire in research on global vegetation-climate change dynamics and conservation planning

Distribution and Habitat Associations of Billfish and Swordfish Larvae across Mesoscale Features in the Gulf of Mexico

Ichthyoplankton surveys were conducted in surface waters of the northern Gulf of Mexico (NGoM) over a three-year period (2006–2008) to determine the relative value of this region as early life habitat of sailfish (Istiophorus platypterus), blue marlin (Makaira nigricans), white marlin (Kajikia albida), and swordfish (Xiphias gladius). Sailfish were the dominant billfish collected in summer surveys, and larvae were present at 37.5% of the stations sampled. Blue marlin and white marlin larvae were present at 25.0% and 4.6% of the stations sampled, respectively, while swordfish occurred at 17.2% of the stations. Areas of peak production were detected and maximum density estimates for sailfish (22.09 larvae 1000 m−2) were significantly higher than the three other species: blue marlin (9.62 larvae 1000 m−2), white marlin (5.44 larvae 1000 m−2), and swordfish (4.67 larvae 1000 m−2). The distribution and abundance of billfish and swordfish larvae varied spatially and temporally, and several environmental variables (sea surface temperature, salinity, sea surface height, distance to the Loop Current, current velocity, water depth, and Sargassum biomass) were deemed to be influential variables in generalized additive models (GAMs). Mesoscale features in the NGoM affected the distribution and abundance of billfish and swordfish larvae, with densities typically higher in frontal zones or areas proximal to the Loop Current. Habitat suitability of all four species was strongly linked to physicochemical attributes of the water masses they inhabited, and observed abundance was higher in slope waters with lower sea surface temperature and higher salinity. Our results highlight the value of the NGoM as early life habitat of billfishes and swordfish, and represent valuable baseline data for evaluating anthropogenic effects (i.e., Deepwater Horizon oil spill) on the Atlantic billfish and swordfish populations