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

Opportunities for system level improvement in antibiotic use across the surgical pathway

Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery) is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery), with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement

Host Selection of the giant willow aphid (Tuberolachnus salignus)

The giant willow aphid [Tuberolachnus salignus (Gmelin)] has recently become noteworthy as a potential pest species due to the increased uptake of willow, its host-plant, for use in growing biomass for energy production. In this paper we describe host selection studies of T. salignus on short rotation coppice (SRC) willow varieties in laboratory bioassays and field experiments. In laboratory olfactometry tests, T. salignus was significantly attracted to certain SRC willow varieties, but not to others. Field trials during 2007 and 2008 showed that T. salignus infestation levels varied significantly on different SRC willow varieties and that levels are highest on the varieties to which they are most strongly attracted in the laboratory bioassays

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

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

Is the Insect Apocalypse upon us? How to Find Out

In recent decades, entomologists have documented alarming declines in occurrence, taxonomic richness, and geographic range of insects around the world. Additionally, some recent studies have reported that insect abundance and biomass, often of common species, are rapidly declining, which has led some to dub the phenomenon an “Insect Apocalypse”. Recent reports are sufficiently robust to justify immediate actions to protect insect biodiversity worldwide. We caution, however, that we do not yet have the data to assess large-scale spatial patterns in the severity of insect trends. Most documented collapses are from geographically restricted studies and, alone, do not allow us to draw conclusions about insect declines on continental or global scales, especially with regards to future projections of total insect biomass, abundance, and extinction. There are many challenges to understanding insect declines: only a small fraction of insect species have had any substantial population monitoring, millions of species remain unstudied, and most of the long-term population data for insects come from human-dominated landscapes in western and northern Europe. But there are still concrete steps we can take to improve our understanding of potential declines. Here, we review the challenges scientists face in documenting insect population and diversity trends, including communicating their findings, and recommend research approaches needed to address these challenges

Just noticeable differences for pitch direction, height, and slope for Mandarin and English listeners

Previous studies on tones suggest that Mandarin listeners are more sensitive to pitch direction and slope while English listeners primarily attend to pitch height. In this study, just noticeable differences were established for pitch discrimination using a three-interval, forced-choice procedure with a two-down, one-up staircase design. A high rising and a high falling Mandarin tone were manipulated in terms of pitch direction, height, and slope. Results indicate that, overall, Mandarin listeners are more sensitive to pitch slope and English listeners to pitch height. However, these effects are modulated by both the direction (falling/rising) and slope of the pitch contours

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<sub>3</sub>I ionisation scheme. RHs studied were <1, 11, 21, 27, 30 % and formic acid yields of (0.07±0.01) and (0.41±0.07) were determined at <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<sub>2</sub>OO with water compared with decomposition. This analysis suggests that the rate of reaction with water ranges between 1×10<sup>−12</sup>–1×10<sup>−15</sup> cm<sup>3</sup> molecule<sup>−1</sup> s<sup>−1</sup> and will therefore dominate its loss with respect to bimolecular processes in the atmosphere. Global model integrations suggest that this reaction between CH<sub>2</sub>OO and water may dominate the production of HC(O)OH in the atmosphere

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

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