Freedom of Information Act: scalpel or just a sharp knife?

The concluding statement of the Burns Commission, established to evaluate whether changes are needed to the Freedom of Information Act (FOIA), ruled no major legislative changes were required. As such Freedom of Information (FOI) legislation still enables anyone to obtain information from public authorities. In this brief report article we explore arguments regarding FOI as an instrument for healthcare research using an international research programme as a case study

A meta-analysis of techniques to promote motivation for health behaviour change from a self-determination theory perspective

A systematic review and meta-analysis was conducted of the techniques used to promote psychological need satisfaction and motivation within health interventions based on self-determination theory (SDT; Ryan & Deci, 2017. Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York, NY: Guilford Press). Eight databases were searched from 1970 to 2017. Studies including a control group and reporting pre- and post-intervention ratings of SDT-related psychosocial mediators (namely perceived autonomy support, need satisfaction and motivation) with children or adults were included. Risk of bias was assessed using items from the Cochrane risk of bias tool. 2496 articles were identified of which 74 met inclusion criteria; 80% were RCTs or cluster RCTs. Techniques to promote need supportive environments were coded according to two established taxonomies (BCTv1 and MIT), and 21 SDT-specific techniques, and grouped into 18 SDT based strategies. Weighted mean effect sizes were computed using a random effects model; perceived autonomy support g = 0.84, autonomy g = 0.81, competence g = 0.63, relatedness g = 0.28, and motivation g = 0.41. One-to-one interventions resulted in greater competence satisfaction than group-based (g = 0.96 vs. 0.28), and competence satisfaction was greater for adults (g = 0.95) than children (g = 0.11). Meta-regression analysis showed that individual strategies had limited independent impact on outcomes, endorsing the suggestion that a need supportive environment requires the combination of multiple co-acting techniques

COVID-19 and the HIV care continuum in Uganda: minimising collateral damage

The novel coronavirus, SARS-CoV-2, has spread across the world within months of its first description in Wuhan, China in December 2019, resulting in an unprecedented global health emergency. Whilst Europe and North America are the current epicentres of infection, the global health community are preparing for the potential effects of this new disease on the African continent. Modelling studies predict that factors such as a youthful and rural population may be protective in mitigating the spread of COVID-19 in the World Health Organisation (WHO) African Region, however, with 220 million infections and 4.6 million hospitalisations predicted in the first year of the pandemic alone, fragile health systems could still be placed under significant strain. Furthermore, subsequent disruptions to the provision of services for people living with HIV, or at risk of acquiring HIV, are predicted to lead to an extra 500,000 adult HIV deaths and a 2-fold increase in mother to child transmission of HIV in sub-Saharan Africa in 2020-2021. Ignoring these predictions may have severe consequences and we risk �stepping back in time� in AIDS-related deaths to numbers seen over a decade ago. Reflecting on our current experience of the COVID-19 pandemic in Uganda, we explore the potential impact of public health measures implemented to mitigate spread of COVID-19 on the HIV care continuum, and suggest areas of focus for HIV services, policy makers and governments to urgently address in order to minimise the collateral damage

Air quality evaluation of London Paddington train station

Enclosed railway stations hosting diesel trains are at risk of reduced air quality as a result of exhaust emissions that may endanger passengers and workers. Air quality measurements were conducted inside London Paddington Station, a semi-enclosed railway station where 70% of trains are powered by diesel engines. Particulate matter (PM2.5) mass was measured at five station locations. PM size, PM number, oxides of nitrogen (NOx), and sulfur dioxide (SO2) were measured at two station locations. Paddington Station’s hourly mean PM2.5 mass concentrations averaged 16 μg/m3 [min 2, max 68]. Paddington Station’s hourly mean NO2 concentrations averaged 73 ppb [49, 120] and SO2 concentrations averaged 25 ppb [15, 37]. While UK train stations are not required to comply with air quality standards, there were five instances where the hourly mean NO2 concentrations exceeded the EU hourly mean limits (106 ppb) for outdoor air quality. PM2.5, SO2, and NO2 concentrations were compared against Marylebone, a busy London roadside 1.5 km from the station. The comparisons indicated that train station air quality was more polluted than the nearby roadside. PM2.5 for at least one measurement location within Paddington Station was shown to be statistically higher (P-value < 0.05) than Marylebone on 3 out of 4 days. Measured NO2 within Paddington Station was statistically higher than Marylebone on 4 out of 5 days. Measured SO2 within Paddington Station was statistically higher than Marylebone on all 3 days.We thank the Engineering and Physical Sciences Research Council (EP/F034350/1) for funding the Energy Efficient Cities Initiative and the Schiff Foundation for doctoral studentship funding.This is the final version of the article. It first appeared from IOP via http://dx.doi.org/10.1088/1748-9326/10/9/09401

Cerebrospinal Fluid Bacillary Load by Xpert MTB/RIF Ultra Polymerase Chain Reaction Cycle Threshold Value Predicts 2-Week Mortality in Human Immunodeficiency Virus-Associated Tuberculous Meningitis.

BACKGROUND: The World Health Organization recommends GeneXpert MTB/RIF Ultra (Xpert Ultra), a fully automated polymerase chain reaction (PCR) assay, as the initial tuberculous meningitis (TBM) diagnostic test. The assay's PCR cycle threshold (Ct) values represent the number of PCR cycles required for probe signal to be detected (low Ct value = high bacillary load) and may approximate tuberculosis (TB) bacillary load. We measured the relationship between cerebrospinal fluid (CSF) TB bacillary load with mortality. METHODS: We prospectively enrolled 102 human immunodeficiency virus (HIV)-positive Ugandans with probable or definite TBM from April 2015 to August 2019. Xpert Ultra Ct tertiles and semi-quantitative categories were separately analyzed as predictors of 2-week mortality. We investigated associations between Ct and baseline clinical and CSF parameters. RESULTS: Subjects with Ct values in the low tertile (ie, high bacillary load) had 57% 2-week mortality-worse than the intermediate (17%) and high (25%) Ct tertiles and Xpert Ultra-negative (30%) probable TBM cases (P = .01). In contrast, the reported semi-quantitative Xpert Ultra categorization was less precise; with the medium to low category trending toward worse 2-week survival (42%) compared with very low (28%), trace (26%), and negative (30%) categories (P = .48). Ct tertile was significantly associated with baseline CSF lactate (P = .03). CONCLUSIONS: High CSF TB bacillary load, as measured by Xpert Ultra Ct tertile, is associated with an almost 2-fold higher 2-week mortality in HIV-associated TBM and is a better predictor than the reported Xpert Ultra semi-quantitative category. Xpert Ultra Ct values could identify TBM patients at increased risk of death who may benefit from enhanced supportive care

Evaluation of polygenic risk scores for breast and ovarian cancer risk prediction in BRCA1 and BRCA2 mutation carriers

Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2 x 10(53)). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2 x 10(-20)). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management

West-Life: A Virtual Research Environment for structural biology

The West-Life project (https://about.west-life.eu/)is a Horizon 2020 project funded by the European Commission to provide data processing and data management services for the international community of structural biologists, and in particular to support integrative experimental approaches within the field of structural biology. It has developed enhancements to existing web services for structure solution and analysis, created new pipelines to link these services into more complex higher-level workflows, and added new data management facilities. Through this work it has striven to make the benefits of European e-Infrastructures more accessible to life-science researchers in general and structural biologists in particular