Epidemics

This chapter reflects on the changing nature of humanitarian engagement with epidemics. Case studies analysing outbreaks of cholera in North Kivu, Zaire in 1994 and Haiti in 2010 as well as an outbreak of polio in the Horn of Africa in 2013 demonstrate the importance of looking behind narratives of ‘success’ and ‘failure’ to explore the challenges facing humanitarian agencies working in diverse social, political and resource-poor settings. Many of these challenges remain enduring, with the recent outbreak of Ebola in West Africa demonstrating that both the scale and nature of humanitarian assistance is currently being shaped by narratives linking health and disease with global security. It is also evident that assistance tends to be more effective in those places where humanitarian agencies co-ordinate their activities, while simultaneously adapting their work to the unique social, political and economic contexts in which epidemics occur

The case of the exploding egg

The vast majority of paediatric burns occur in developing countries, and many of these injuries are entirely preventable. In general, four paediatric injury patterns have been identified in toddlers and infants, who are at a significantly increased risk of burn injuries. Children <2 years of age are often innocent bystanders, but as they grow older physical mobility, social independence and gender-specific high-risk activities come into play

Dependence on RAD52 and RAD1 for anticancer drug resistance mediated by inactivation of mismatch repair genes

AbstractMismatch repair (MMR) proteins repair mispaired DNA bases and have an important role in maintaining the integrity of the genome [1]. Loss of MMR has been correlated with resistance to a variety of DNA-damaging agents, including many anticancer drugs [2]. How loss of MMR leads to resistance is not understood, but is proposed to be due to loss of futile MMR activity and/or replication stalling [3,4]. We report that inactivation of MMR genes (MLH1, MLH2, MSH2, MSH3, MSH6, but not PMS1) in isogenic strains of Saccharomyces cerevisiae led to increased resistance to the anticancer drugs cisplatin, carboplatin and doxorubicin, but had no effect on sensitivity to ultraviolet C (UVC) radiation. Sensitivity to cisplatin and doxorubicin was increased in mlh1 mutant strains when the MLH1 gene was reintroduced, demonstrating a direct involvement of MMR proteins in sensitivity to these DNA-damaging agents. Inactivation of MLH1, MLH2 or MSH2 had no significant effect, however, on drug sensitivities in the rad52 or rad1 mutant strains that are defective in mitotic recombination and removing unpaired DNA single strands. We propose a model whereby MMR proteins – in addition to their role in DNA-damage recognition – decrease adduct tolerance during DNA replication by modulating the levels of recombination-dependent bypass. This hypothesis is supported by the finding that, in human ovarian tumour cells, loss of hMLH1 correlated with acquisition of cisplatin resistance and increased cisplatin-induced sister chromatid exchange, both of which were reversed by restoration of hMLH1 expression

Utilization of a Palliative Care Trigger in the Surgical Intensive Care Unit

Our project aims to expand palliative care availability in the SICU by implementing a consult trigger program. We also aim to learn about and measure compassion fatigue of providers within the SICU

How can countries create outbreak response policies that are sensitive to maternal health?

From BMJ via Jisc Publications RouterEnsuring women’s need for sexual and reproductive healthcare are met should be a priority during disease outbreaks, say Maira L S Takemoto and colleaguesOpen access fees were paid by the UN University-International Institute for Global Health.373pubpu

The response is like a big ship': community feedback as a case study of evidence uptake and use in the 2018-2020 Ebola epidemic in the Democratic Republic of the Congo.

INTRODUCTION: The 2018-2020 Ebola outbreak in the Democratic Republic of the Congo (DRC) took place in the highly complex protracted crisis regions of North Kivu and Ituri. The Red Cross developed a community feedback (CF) data collection process through the work of hundreds of Red Cross personnel, who gathered unprompted feedback in order to inform the response coordination mechanism and decision-making. AIM: To understand how a new CF system was used to make operational and strategic decisions by Ebola response leadership. METHODS: Qualitative data collection in November 2019 in Goma and Beni (DRC), including document review, observation of meetings and CF activities, key informant interviews and focus group discussions. FINDINGS: The credibility and use of different evidence types was affected by the experiential and academic backgrounds of the consumers of that evidence. Ebola response decision-makers were often medics or epidemiologists who tended to view quantitative evidence as having more rigour than qualitative evidence. The process of taking in and using evidence in the Ebola response was affected by decision-makers' bandwidth to parse large volumes of data coming from a range of different sources. The operationalisation of those data into decisions was hampered by the size of the response and an associated reduction in agility to new evidence. CONCLUSION: CF data collection has both instrumental and intrinsic value for outbreak response and should be normalised as a critical data stream; however, a failure to act on those data can further frustrate communities

The Cluster Mass Function from Early SDSS Data: Cosmological Implications

The mass function of clusters of galaxies is determined from 400 deg^2 of early commissioning imaging data of the Sloan Digital Sky Survey; ~300 clusters in the redshift range z = 0.1 - 0.2 are used. Clusters are selected using two independent selection methods: a Matched Filter and a red-sequence color magnitude technique. The two methods yield consistent results. The cluster mass function is compared with large-scale cosmological simulations. We find a best-fit cluster normalization relation of sigma_8*omega_m^0.6 = 0.33 +- 0.03 (for 0.1 ~< omega_m ~< 0.4), or equivalently sigma_8 = (0.16/omega_m)^0.6. The amplitude of this relation is significantly lower than the previous canonical value, implying that either omega_m is lower than previously expected (omega_m = 0.16 if sigma_8 = 1) or sigma_8 is lower than expected (sigma_8 = 0.7 if omega_m = 0.3). The best-fit mass function parameters are omega_m = 0.19 (+0.08,-0.07) and sigma_8 = 0.9 (+0.3,-0.2). High values of omega_m (>= 0.4) and low sigma_8 (=~ 2 sigma.Comment: AASTeX, 25 pages, including 7 figures, accepted for publication in ApJ, vol.585, March 200

High-Redshift Quasars Found in Sloan Digital Sky Survey Commissioning Data IV: Luminosity Function from the Fall Equatorial Stripe Sampl

This is the fourth paper in a series aimed at finding high-redshift quasars from five-color imaging data taken along the Celestial Equator by the SDSS. during its commissioning phase. In this paper, we use the color-selected sample of 39 luminous high-redshift quasars presented in Paper III to derive the evolution of the quasar luminosity function over the range of 3.6<z<5.0, and -27.5<M_1450<-25.5 (Omega=1, H_0=50 km s^-1 Mpc^-1). We use the selection function derived in Paper III to correct for sample incompleteness. The luminosity function is estimated using three different methods: (1) the 1/V_a estimator; (2) a maximum likelihood solution, assuming that the density of quasars depends exponentially on redshift and as a power law in luminosity and (3) Lynden-Bell's non-parametric C^- estimator. All three methods give consistent results. The luminous quasar density decreases by a factor of ~ 6 from z=3.5 to z=5.0, consistent with the decline seen from several previous optical surveys at z<4.5. The luminosity function follows psi(L) ~ L^{-2.5} for z~4 at the bright end, significantly flatter than the bright end luminosity function psi(L) \propto L^{-3.5} found in previous studies for z<3, suggesting that the shape of the quasar luminosity function evolves with redshift as well, and that the quasar evolution from z=2 to 5 cannot be described as pure luminosity evolution. Possible selection biases and the effect of dust extinction on the redshift evolution of the quasar density are also discussed.Comment: AJ accepted, with minor change

Home self-administration of intravenous antibiotics as part of an outpatient parenteral antibiotic therapy service: a qualitative study of the perspectives of patients who do not self-administer

Objectives: This study aimed to use a theoretical approach to understand the determinants of behaviour in patients not home self-administering intravenous antibiotics. Setting: Outpatient care: included patients were attending an outpatient clinic for intravenous antibiotic administration in the northeast of Scotland. Participants: Patients were included if they had received more than 7 days of intravenous antibiotics and were aged 16 years and over. Twenty potential participants were approached, and all agreed to be interviewed. 13 were male with a mean age of 54 years (SD +17.6). Outcomes: Key behavioural determinants that influenced patients’ behaviours relating to self-administration of intravenous antibiotics. Design: Qualitative, semistructured in-depth interviews were undertaken with a purposive sample of patients. An interview schedule, underpinned by the Theoretical Domains Framework (TDF), was developed, reviewed for credibility and piloted. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically using the TDF as the coding framework. Results: The key behavioural determinants emerging as encouraging patients to self-administer intravenous antibiotics were the perceptions of being sufficiently knowledgeable, skilful and competent and that self-administration afforded the potential to work while administering treatment. The key determinants that impacted their decision not to self-administer were lack of knowledge of available options, a perception that hospital staff are better trained and anxieties of potential complications. Conclusion: Though patients are appreciative of the skills and knowledge of hospital staff, there is also a willingness among patients to home self-administer antibiotics. However, the main barrier emerges to be a perceived lack of knowledge of ways of doing this at home. To overcome this, a number of interventions are suggested based on evidence-based behavioural change techniques

Towards an understanding of resilience: responding to health systems shocks.

The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that health systems need not only to be stronger but also more 'resilient'. In this article, we argue that responding to shocks is an important aspect of resilience, examining the health system behaviour in the face of four types of contemporary shocks: the financial crisis in Europe from 2008 onwards; climate change disasters; the EVD outbreak in West Africa 2013-16; and the recent refugee and migration crisis in Europe. Based on this analysis, we identify '3 plus 2' critical dimensions of particular relevance to health systems' ability to adapt and respond to shocks; actions in all of these will determine the extent to which a response is successful. These are three core dimensions corresponding to three health systems functions: 'health information systems' (having the information and the knowledge to make a decision on what needs to be done); 'funding/financing mechanisms' (investing or mobilising resources to fund a response); and 'health workforce' (who should plan and implement it and how). These intersect with two cross-cutting aspects: 'governance', as a fundamental function affecting all other system dimensions; and predominant 'values' shaping the response, and how it is experienced at individual and community levels. Moreover, across the crises examined here, integration within the health system contributed to resilience, as does connecting with local communities, evidenced by successful community responses to Ebola and social movements responding to the financial crisis. In all crises, inequalities grew, yet our evidence also highlights that the impact of shocks is amenable to government action. All these factors are shaped by context. We argue that the '3 plus 2' dimensions can inform pragmatic policies seeking to increase health systems resilience