Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review

Introduction The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. Methods A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. Results 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. Conclusion The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation efforts should be focussed, and also how to build contingency at the strategic level for agile responses to macro-level environmental influences

Outdoor learning spaces: the case of forest school

© 2017 The Author. Area published by John Wiley & Sons Ltd on behalf of Royal Geographical Society (with the Institute of British Geographers). This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.This paper contributes to the growing body of research concerning use of outdoor spaces by educators, and the increased use of informal and outdoor learning spaces when teaching primary school children. The research takes the example of forest school, a form of regular and repeated outdoor learning increasingly common in primary schools. This research focuses on how the learning space at forest school shapes the experience of children and forest school leaders as they engage in learning outside the classroom. The learning space is considered as a physical space, and also in a more metaphorical way as a space where different behaviours are permitted, and a space set apart from the national curriculum. Through semi-structured interviews with members of the community of practice of forest school leaders, the paper seeks to determine the significance of being outdoors on the forest school experience. How does this learning space differ from the classroom environment? What aspects of the forest school learning space support pupils’ experiences? How does the outdoor learning space affect teaching, and the dynamics of learning while at forest school? The research shows that the outdoor space provides new opportunities for children and teachers to interact and learn, and revealed how forest school leaders and children co-create a learning environment in which the boundaries between classroom and outdoor learning, teacher and pupil, are renegotiated to stimulate teaching and learning. Forest school practitioners see forest school as a separate learning space that is removed from the physical constraints of the classroom and pedagogical constraints of the national curriculum to provide a more flexible and responsive learning environment.Peer reviewe

Project MOSI: rationale and pilot-study results of an initiative to help protect zoo animals from mosquito-transmitted pathogens and contribute data on mosquito spatio–temporal distribution change

Mosquito-borne pathogens pose major threats to both wildlife and human health and, largely as a result of unintentional human-aided dispersal of their vector species, their cumulative threat is on the rise. Anthropogenic climate change is expected to be an increasingly significant driver of mosquito dispersal and associated disease spread. The potential health implications of changes in the spatio-temporal distribution of mosquitoes highlight the importance of ongoing surveillance and, where necessary, vector control and other health-management measures. The World Association of Zoos and Aquariums initiative, Project MOSI, was established to help protect vulnerable wildlife species in zoological facilities from mosquito-transmitted pathogens by establishing a zoo-based network of fixed mosquito monitoring sites to assist wildlife health management and contribute data on mosquito spatio-temporal distribution changes. A pilot study for Project MOSI is described here, including project rationale and results that confirm the feasibility of conducting basic standardized year-round mosquito trapping and monitoring in a zoo environment

Real-World Data and Randomised Controlled Trials: The Salford Lung Study

Traditional efficacy double-blind randomised controlled trials (DBRCTs) measure the benefit a treatment produces under near-ideal test conditions in highly selected patient populations; however, the behaviour of patients and investigators in such trials is highly controlled, highly compliant and adherent, and non-representative of routine clinical practice. Pragmatic effectiveness trials measure the benefit a treatment produces in patients in everyday “real-world” practice. Ideally, effectiveness trials should recruit patients as similar as possible to those who will ultimately be prescribed the medicine, and create freedom within the study design to allow normal behaviours of patients and healthcare professionals (HCPs) to be expressed. The Salford Lung Study (SLS) was a world-first, prospective, phase III, pragmatic randomised controlled trial (RCT) programme in patients with chronic obstructive pulmonary disease and asthma to evaluate the effectiveness of a pre-licensed medication (fluticasone furoate/vilanterol) in real-world practice using electronic health records and through collaboratively engaging general practitioners and community pharmacists in clinical research. The real-world aspect of SLS was unique, requiring careful planning and attention to the goals of maximising the external validity of the trials while maintaining scientific rigour and securing suitable electronic processes for proper interpretation of safety data. Key learnings from SLS that may inform the design of future pragmatic effectiveness RCTs include: (1) ensuring the trial setting and operational infrastructure are aligned with routine clinical care; (2) recruiting a broad patient population with characteristics as close as possible to patients in routine clinical practice, to maximise the generalisability and applicability of trial results; (3) ensuring that patients and HCPs are suitably engaged in the trial, to maximise the chances of successful trial delivery; and (4) careful study design, incorporating outcomes of value to patients, HCPs, policymakers and payers, and using pre-planned analyses to address scientifically valid research hypotheses to ensure robustness of the trial data.</p

Acid-yield measurements of the gas-phase ozonolysis of ethene as a function of humidity using Chemical Ionisation Mass Spectrometry (CIMS)

Gas-phase ethene ozonolysis experiments were conducted at room temperature to determine formic acid yields as a function of relative humidity (RH) using the integrated EXTreme RAnge chamber-Chemical Ionisation Mass Spectrometry technique, employing a CH&lt;sub&gt;3&lt;/sub&gt;I ionisation scheme. RHs studied were &lt;1, 11, 21, 27, 30 % and formic acid yields of (0.07±0.01) and (0.41±0.07) were determined at &lt;1 % RH and 30 % RH respectively, showing a strong water dependence. It has been possible to estimate the ratio of the rate coefficient for the reaction of the Criegee biradical, CH&lt;sub&gt;2&lt;/sub&gt;OO with water compared with decomposition. This analysis suggests that the rate of reaction with water ranges between 1×10&lt;sup&gt;−12&lt;/sup&gt;–1×10&lt;sup&gt;−15&lt;/sup&gt; cm&lt;sup&gt;3&lt;/sup&gt; molecule&lt;sup&gt;−1&lt;/sup&gt; s&lt;sup&gt;−1&lt;/sup&gt; and will therefore dominate its loss with respect to bimolecular processes in the atmosphere. Global model integrations suggest that this reaction between CH&lt;sub&gt;2&lt;/sub&gt;OO and water may dominate the production of HC(O)OH in the atmosphere

Native Speaker Perceptions of Accented Speech: The English Pronunciation of Macedonian EFL Learners

The paper reports on the results of a study that aimed to describe the vocalic and consonantal features of the English pronunciation of Macedonian EFL learners as perceived by native speakers of English and to find out whether native speakers who speak different standard variants of English perceive the same segments as non-native. A specially designed computer web application was employed to gather two types of data: a) quantitative (frequency of segment variables and global foreign accent ratings on a 5-point scale), and b) qualitative (open-ended questions). The result analysis points out to three most frequent markers of foreign accent in the English speech of Macedonian EFL learners: final obstruent devoicing, vowel shortening and substitution of English dental fricatives with Macedonian dental plosives. It also reflects additional phonetic aspects poorly explained in the available reference literature such as allophonic distributional differences between the two languages and intonational mismatch

Access to shops: The views of low-income shoppers

Concern is mounting as the retail stranglehold upon access to food grows. Research on the implications of restructuring retailing and health inequality has failed to involve low-income consumers in this debate. This paper reports on an exercise conducted for the UK Government's, Social Exclusion Unit's Policy Action Team on Access to Shops. The survey provides a useful baseline of the views of low-income groups in England. The choices that people on low income can make were found to be dominated by certain factors such as income and, most importantly, transport. Consumers reported varying levels of satisfaction with retail provision. The findings suggest gaps between what people have, what they want and what the planning process does and does not offer them. Better policy and processes are needed to include and represent the interests of low-income groups

Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers.

BACKGROUND: Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging 'post-conflict' contexts. However, analyses on the adoption of technology for health (that is, 'e-health') and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations. METHODS: This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger's diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis. RESULTS: All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination. CONCLUSIONS: Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users

Current management of treatment-induced bone loss in women with breast cancer treated in the United Kingdom

New therapeutic options in breast cancer have improved survival but consequently increase the relevance of late complications. Ovarian suppression/ablation and aromatase inhibitors (AI) in the adjuvant setting have improved outcome, but have clinically important adverse effects on bone health. However, investigation and management of cancer treatment-induced bone loss (CTIBL) is poorly defined with no national guidance. In 2004, a questionnaire was sent to over 500 breast surgeons and oncologists who treat breast cancer within the United Kingdom. The questionnaire evaluated access to bone densitometry and specialist expertise as well as attitudes to investigation of CTIBL and anticipated changes in the use of AI for postmenopausal early breast cancer. A total of 354 completed questionnaires were received, 47 from clinicians not currently treating breast cancer. Of the 307 evaluable questionnaires, 164 (53%) were from breast surgeons, 112 (36%) from clinical oncologists and 31 (10%) from medical oncologists. Although most respondents recognised that CTIBL was the responsibility of the treating breast team, investigations for CTIBL are limited even though most had adequate access to bone densitometry; 98 (32%) had not requested a DXA scan in the last 6 months and 224 (73%) had requested fewer than five scans. In all, 235 (76%) were not routinely investigating patients on AI for bone loss. A total of 277 (90%) felt that their practice would benefit from national guidelines to manage these patients, and the majority (59%) had little or no confidence in interpreting DXA results and advising on treatment. This questionnaire has highlighted clear deficiencies in management of CTIBL in early breast cancer. The development of national guidelines for the management of these patients and educational initiatives for breast teams are urgently required