Generationing development

The articles in this special issue present a persuasive case for accounts of development to recognise the integral and fundamental roles played by age and generation. While the past two decades have witnessed a burgeoning of literature demonstrating that children and youth are impacted by development, and that they can and do participate in development, the literature has tended to portray young people as a special group whose perspectives should not be forgotten. By contrast, the articles collected here make the case that age and generation, as relational constructs, cannot be ignored. Appropriating the term ‘generationing’, the editors argue that a variety of types of age relations profoundly structure the ways in which societies are transformed through development – both immanent processes of neoliberal modernisation and the interventions of development agencies that both respond and contribute to these. Drawing on the seven empirical articles, I attempt to draw some of the ideas together into a narrative that further argues the case for ‘generationing’ but also identifies gaps, questions and implications for further research

A short-lived oxidation event during the early Ediacaran and delayed oxygenation of the Proterozoic ocean

The Ediacaran Period was characterised by major carbon isotope perturbations. The most extreme of these, the ∼570 Ma Shuram/DOUNCE (Doushantuo Negative Carbon isotope Excursion) anomaly, coincided with early radiations of benthic macrofauna linked to a temporary expansion in the extent of oxygenated seawater. Here we document an earlier negative excursion (the ∼610 Ma WANCE (Weng'An Negative Carbon isotope Excursion)) anomaly in the Yangtze Gorges area, South China, that reached equally extreme carbon isotope values and was associated with a similar degree of environmental perturbation. Specifically, new uranium isotope data evidence a significant, but transient, shift towards more oxygenated conditions in tandem with decreasing carbon isotope values, while strontium and sulfur isotope data support an increase in continental weathering through the excursion. We utilize a biogeochemical modelling approach to demonstrate that the influx of such a weathering pulse into an organically-laden, largely anoxic ocean, fully reproduces each of these distinct isotopic trends. Our study directly supports the hypothesis that a large dissolved marine organic pool effectively buffered against widespread oxygenation of the marine environment through the Proterozoic Eon, and in doing so, substantially delayed the radiation of complex aerobic life on Earth

Working in an urgent dental care hub during the Covid-19 pandemic from a dental nurses' perspective

A qualitative study </jats:p

The future of dentistry post-COVID-19: perspectives from Urgent Dental Care centre staff in England

Introduction While routine dentistry was suspended during the COVID-19 pandemic, Urgent Dental Care centres (UDCs) were established to support patients with urgent dental needs. Aim The study aimed to provide insights and recommendations on future dental reform based on the perspectives of frontline staff delivering dental care in UDCs. Method A qualitative research study using a phenomenological approach. A hybrid approach that incorporated both a deductive and an inductive approach to analysis was adopted. Results The sample included 29 dentists and nine dental nurses providing care at UDCs in England during the pandemic. The following predominant themes were identified: patient care and access, practice viability, workforce sustainability, identity of dentistry and contract reform. Conclusions The pandemic has highlighted the desire from the dental profession for urgent reform of the current NHS dental contract in England. This was directed towards a more resilient, responsive and equitable dental service that is better prepared for current and future challenges. SUPPLEMENTARY INFORMATION: Zusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-021-3405-1 für autorisierte Leser zusätzliche Dateien abrufbar

Frontline experiences and perceptions of Urgent Dental Care centre staff in England during the COVID-19 pandemic: a qualitative study

Introduction Following the World Health Organisation declaration of COVID-19 as a global pandemic, routine dental care in the UK ceased, and Urgent Dental Care centres (UDCs) were established to offer remote and face-to-face urgent dental treatment for those in need. Aim To explore perceptions and psychosocial experiences of frontline staff providing care at UDCs in England during COVID-19. Method A qualitative research study using a phenomenological approach. Semi-structured interviews were conducted remotely. Using line-by-line coding, data were analysed using a hybrid approach that incorporated both a deductive, theoretical process and an inductive, data-driven process. Results Participants included 29 dentists and nine dental nurses from UDCs across England. Twelve themes were identified and grouped into positive and negative experiences. Positive experiences were: role fulfilment and having a sense of purpose; team unity and collective coping strategies; and strategic teamwork and preparedness for effective organisation of care. Negative experiences included: feeling undervalued and frustrated due to fragmented guidance and communication; sense of unfairness generated by relational challenges; patient demand outstripping UDC capacity; complex decision-making; uncertainty over safety; suffocating PPE hindering effective communication; ineffective communication channels across healthcare sectors; lack of commitment to remote video consultations; and variable referral quality. Conclusions Participants reported experiencing a number of emotional challenges that appeared to be exacerbated by an unsupportive environment, often due to lack of leadership. However, positive experiences and coping strategies were also identified. Collective and sustained efforts at system level to improve the resilience and mental wellbeing of the current and future dental workforce and integration of dentistry into wider healthcare infrastructures are needed. SUPPLEMENTARY INFORMATION: Zusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-021-3375-3 für autorisierte Leser zusätzliche Dateien abrufbar

Tibial torus and toddler's fractures misdiagnosed as transient synovitis: a case series

<p>Abstract</p> <p>Introduction</p> <p>The high incidence of transient synovitis in early childhood makes it the first suspected pathology in a limping child. Trauma, which has long been regarded as a causative factor for transient synovitis, may be underestimated in a non-cooperative toddler.</p> <p>After excluding most serious conditions, such as septic arthritis, a speculative diagnosis of transient synovitis can be made, and this can easily mask a subtle musculoskeletal injury.</p> <p>Case presentations</p> <p>We report the cases of three Caucasian patients (two boys, aged 20-months- and three-years-old, and one girl, aged two-years-old), with tibial torus and toddler's fractures which were late-diagnosed due to an initial misdiagnosis of transient synovitis of the hip.</p> <p>Conclusion</p> <p>In a non-cooperative child musculoskeletal trauma can be mistaken as a simple causative factor for transient synovitis of the hip and this can easily prevent further investigation for a possible subtle musculoskeletal injury of the lower extremities.</p> <p>Our experience with the presented cases suggests the need to be more vigilant in the differential diagnosis of transient synovitis in young children.</p

Cost of increasing access to artemisinin combination therapy: the Cambodian experience

BACKGROUND: Malaria-endemic countries are switching antimalarial drug policy from cheap ineffective monotherapies to artemisinin combination therapies (ACTs) for the treatment of Plasmodium falciparum malaria and the global community are considering setting up a global subsidy to fund their purchase. However, in order to ensure that ACTs are correctly used and are accessible to the poor and remote communities who need them, specific interventions will be necessary and the additional costs need to be considered. METHODS: This paper presents an incremental cost analysis of some of these interventions in Cambodia, the first country to change national antimalarial drug policy to an ACT of artesunate and mefloquine. These costs include the cost of rapid diagnostic tests (RDTs), the cost of blister-packaging the drugs locally and the costs of increasing access to diagnosis and treatment to remote communities through malaria outreach teams (MOTs) and Village Malaria Workers (VMW). RESULTS: At optimum productive capacity, the cost of blister-packaging cost under $0.20 per package but in reality was significantly more than this because of the low rate of production. The annual fixed cost (exclusive of RDTs and drugs) per capita of the MOT and VMW schemes was$0.44 and $0.69 respectively. However because the VMW scheme achieved a higher rate of coverage than the MOT scheme, the cost per patient treated was substantially lower at$5.14 compared to $12.74 per falciparum malaria patient treated. The annual cost inclusive of the RDTs and drugs was$19.31 for the MOT scheme and $11.28 for the VMW scheme given similar RDT positivity rates of around 22% and good provider compliance to test results. CONCLUSION: In addition to the cost of ACTs themselves, substantial additional investments are required in order to ensure that they reach the targeted population via appropriate delivery systems and to ensure that they are used appropriately. In addition, differences in local conditions, in particular the prevalence of malaria and the pre-existing infrastructure, need to be considered in choosing appropriate diagnostic and delivery strategies

Inequities in incidence, morbidity and expenditures on prevention and treatment of malaria in southeast Nigeria

<p>Abstract</p> <p>Background</p> <p>Malaria places a great burden on households, but the extent to which this is tilted against the poor is unclear. However, the knowledge of the level of the burden of malaria amongst different population groups is vital for ensuring equitable control of malaria. This paper examined the inequities in occurrence, economic burden, prevention and treatment of malaria.</p> <p>Methods</p> <p>The study was undertaken in four malaria endemic villages in Enugu state, southeast Nigeria. Data was collected using interviewer-administered questionnaires. An asset-based index was used to categorize the households into socio-economic status (SES) quartiles: least poor; poor; very poor; and most poor. Chi-square analysis was used to determine the statistical significance of the SES differences in incidence, length of illness, ownership of treated nets, expenditures on treatment and prevention.</p> <p>Results</p> <p>All the SES quartiles had equal exposure to malaria. The pattern of health seeking for all the SES groups was almost similar, but in one of the villages the most poor, very poor and poor significantly used the services of patent medicine vendors and the least poor visited hospitals. The cost of treating malaria was similar across the SES quartiles. The average expenditure to treat an episode of malaria ranged from as low as 131 Naira ($1.09) to as high as 348 Naira ($2.9), while the transportation expenditure to receive treatment ranged from 26 Naira to 46 Naira (both less than $1). The level of expenditure to prevent malaria was low in the four villages, with less than 5% owning untreated nets and 10.4% with insecticide treated nets.</p> <p>Conclusion</p> <p>Malaria constitutes a burden to all SES groups, though the poorer socio-economic groups were more affected, because a greater proportion of their financial resources compared to their income are spent on treating the disease. The expenditures to treat malaria by the poorest households could lead to catastrophic health expenditures. Effective pro-payment health financing and health delivery methods for the treatment and prevention of malaria are needed to decrease the burden of the disease to the most-poor people.</p

Cascading signaling pathways improve the fidelity of a stochastically and deterministically simulated molecular RS latch

<p>Abstract</p> <p>Background</p> <p>While biological systems have often been compared with digital systems, they differ by the strong effect of crosstalk between signals due to diffusivity in the medium, reaction kinetics and geometry. Memory elements have allowed the creation of autonomous digital systems and although biological systems have similar properties of autonomy, equivalent memory mechanisms remain elusive. Any such equivalent memory system, however, must silence the effect of crosstalk to maintain memory fidelity.</p> <p>Results</p> <p>Here, we present a system of enzymatic reactions that behaves like an RS latch (a simple memory element in digital systems). Using both a stochastic molecular simulator and ordinary differential equation simulator, we showed that crosstalk between two latches operating in the same spatial localization disrupts the memory fidelity of both latches. Crosstalk was reduced or silenced when simple reaction loops were replaced with multiple step or cascading reactions, showing that cascading signaling pathways are less susceptible to crosstalk.</p> <p>Conclusion</p> <p>Thus, the common biological theme of cascading signaling pathways is advantageous for maintaining the fidelity of a memory latch in the presence of crosstalk. The experimental implementation of such a latch system will lead to novel approaches to cell control using synthetic proteins and will contribute to our understanding of why cells behave differently even when given the same stimulus.</p