Environmental and organisational drivers influencing the adoption of unified communications technology in South Africa

Includes abstract.Includes bibliographical references (leaves 167-174).Even though Information technology (IT) adoption has been widely studied most of this research has been conducted from within a limited set of perspectives. This study used a combination of perspectives as lenses to understand the factors that enable the adoption of unified communications in South Africa

Virtual consultations for patients with Obstructive Sleep Apnoea:systematic review and meta-analysis

Background: The COVID-19 pandemic has accelerated the adoption of virtual care strategies for the management of patients with Obstructive Sleep Apnoea/Hypopnoea Syndrome. Research question: What is the effectiveness of virtual consultations compared to in-person consultations for the management of Continuous Positive Airway Pressure therapy in adult patients with Obstructive Sleep Apnoea/Hypopnoea Syndrome? Methods: A systematic review and meta-analysis (PROSPERO; CRD42022297532) based on six electronic databases plus manually selected journals was conducted in January 2022. Two researchers independently selected, quality appraised, and extracted data. The co-primary outcomes were patient-reported sleepiness, assessed by the Epworth Sleepiness Scale, and reported cost-effectiveness. Findings: 12 studies (n=1823 adults) were included in the review. Seven studies (n=1089) were included in the meta-analysis which showed no difference in the magnitude of improvement in patient-reported sleepiness scores between virtual and in-person consultations (MD [95%CI], -0.39 [-1.38 to 0.60]; p=0.4), though Epworth Sleepiness Scale scores improved in both groups. Virtual care strategies modestly increased Continuous Positive Airway Pressure therapy adherence and were found to be less costly than in-person care strategies in the three Spanish trials that reported cost-effectiveness. Conclusion: The findings of this review suggest that virtual care delivered by telephone or video consultations is as effective as in-person consultations for improving subjective sleepiness in patients with Obstructive Sleep Apnoea/Hypopnoea Syndrome treated with Continuous Positive Airway Pressure. This clinical management strategy may also improve Continuous Positive Airway Pressure adherence without increasing the costs, supporting its potential as a follow-up management strategy, where patients prefer this approach

At-risk registers integrated into primary care to stop asthma crises in the UK (ARRISA-UK): study protocol for a pragmatic, cluster randomised trial with nested health economic and process evaluations

Background: Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. In our previous research, a secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma patients in primary care. ARRISA involved identifying individuals at risk of adverse asthma events, flagging their electronic health records, training practice staff to develop and implement practice-wide processes of care when alerted by the flag, plus motivational reminders. We now seek to determine the effectiveness and cost-effectiveness of ARRISA in reducing asthma-related crisis events. Methods: We are undertaking a pragmatic, two-arm, multicentre, cluster randomised controlled trial, plus health economic and process evaluation. We will randomise 270 primary care practices from throughout the UK covering over 10,000 registered patients with ‘at-risk asthma’ identified according to a validated algorithm. Staff in practices randomised to the intervention will complete two 45-min eLearning modules (an individually completed module giving background to ARRISA and a group-completed module to develop practice-wide pathways of care) plus a 30-min webinar with other practices. On completion of training at-risk patients’ records will be coded so that a flag appears whenever their record is accessed. Practices will receive a phone call at 4 weeks and a reminder video at 6 weeks and 6 months. Control practices will continue to provide usual care. We will extract anonymised routine patient data from primary care records (with linkage to secondary care data) to determine the percentage of at-risk patients with an asthma-related crisis event (accident and emergency attendances, hospitalisations and deaths) after 12 months (primary outcome). We will also capture the time to crisis event, all-cause hospitalisations, asthma control and any changes in practice asthma management for at-risk and all patients with asthma. Cost-effectiveness analysis and mixed-methods process evaluations will also be conducted. Discussion: This study is novel in terms of using a practice-wide intervention to target and engage with patients at risk from their asthma and is innovative in the use of routinely captured data with record linkage to obtain trial outcomes. Trial registration: ISRCTN95472706. Registered on 5 December 2014

The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review

Introduction: Financial incentives are utilised in healthcare systems in a number of countries to improve quality of care delivered to patients by rewarding practices or practitioners for achieving set targets. Objectives: To systematically review the evidence investigating the impact of financial incentives for implementation of supported self-management on quality of care including: organisational process outcomes, individual behavioural outcomes, and health outcomes for individuals with asthma or diabetes; both conditions with an extensive evidence base for self-management. Methods: We followed Cochrane methodology, using a PICOS search strategy to search eight databases in November 2015 (updated May 2017) including a broad range of implementation methodologies. Studies were weighted by robustness of methodology, number of participants and the quality score. We used narrative synthesis due to heterogeneity of studies. Results: We identified 2,541 articles; 12 met our inclusion criteria. The articles were from the US (n = 7), UK (n = 4) and Canada (n = 1). Measured outcomes were HbA1c tests undertaken and/or the level achieved (n = 10), written action plans for asthma (n = 1) and hospital/emergency department visits (n = 1). Three of the studies were part of a larger incentive scheme including many conditions; one focused on asthma; eight focussed on diabetes. In asthma, the proportion receiving ‘perfect care’ (including providing a written action plan) increased from 4% to 88% in one study, and there were fewer hospitalisations/emergency department visits in another study. Across the diabetes studies, quality-of-care/GP performance scores improved in three, were unchanged in six and deteriorated in one. Conclusions: Results for the impact of financial incentives for the implementation of self-management were mixed. The evidence in diabetes suggests no consistent impact on diabetic control. There was evidence from a single study of improved process and health outcomes in asthma. Further research is needed to confirm these findings and understand the process by which financial incentives may impact (or not) on care

Updated radiative forcing estimates of 65 halocarbons and nonmethane hydrocarbons

The direct radiative forcing of 65 chlorofluorocarbons, hydrochlorofluorocarbons, hydrofluorocarbons, hydrofluoroethers, halons, iodoalkanes, chloroalkanes, bromoalkanes, perfluorocarbons and nonmethane hydrocarbons has been evaluated using a consistent set of infrared absorption cross sections. For the radiative transfer models, both line-by-line and random band model approaches were employed for each gas. The line-by-line model was first validated against measurements taken by the Airborne Research Interferometer Evaluation System (ARIES) of the U.K. Meteorological Office; the computed spectrally integrated radiance of agreed to within 2% with experimental measurements. Three model atmospheres, derived from a three-dimensional climatology, were used in the radiative forcing calculations to more accurately represent hemispheric differences in water vapor, ozone concentrations, and cloud cover. Instantaneous, clear-sky radiative forcing values calculated by the line-by-line and band models were in close agreement. The band model values were subsequently modified to ensure exact agreement with the line-by-line model values. Calibrated band model radiative forcing values, for atmospheric profiles with clouds and using stratospheric adjustment, are reported and compared with previous literature values. Fourteen of the 65 molecules have forcings that differ by more than 15% from those in the World Meteorological Organization [1999] compilation. Eleven of the molecules have not been reported previously. The 65-molecule data set reported here is the most comprehensive and consistent database yet available to evaluate the relative impact of halocarbons and hydrocarbons on climate change

Predicting asthma-related crisis events using routine electronic healthcare data

Background There is no published algorithm predicting asthma crisis events (accident and emergency [A&E] attendance, hospitalisation, or death) using routinely available electronic health record (EHR) data. Aim To develop an algorithm to identify individuals at high risk of an asthma crisis event. Design and setting Database analysis from primary care EHRs of people with asthma across England and Scotland. Method Multivariable logistic regression was applied to a dataset of 61 861 people with asthma from England and Scotland using the Clinical Practice Research Datalink. External validation was performed using the Secure Anonymised Information Linkage Databank of 174 240 patients from Wales. Outcomes were ≥1 hospitalisation (development dataset) and asthma-related hospitalisation, A&E attendance, or death (validation dataset) within a 12-month period. Results Risk factors for asthma-related crisis events included previous hospitalisation, older age, underweight, smoking, and blood eosinophilia. The prediction algorithm had acceptable predictive ability with a receiver operating characteristic of 0.71 (95% confidence interval [CI] = 0.70 to 0.72) in the validation dataset. Using a cut-point based on the 7% of the population at greatest risk results in a positive predictive value of 5.7% (95% CI = 5.3% to 6.1%) and a negative predictive value of 98.9% (95% CI = 98.9% to 99.0%), with sensitivity of 28.5% (95% CI = 26.7% to 30.3%) and specificity of 93.3% (95% CI = 93.2% to 93.4%); those individuals had an event risk of 6.0% compared with 1.1% for the remaining population. In total, 18 people would need to be followed to identify one admission. Conclusion This externally validated algorithm has acceptable predictive ability for identifying patients at high risk of asthma-related crisis events and excluding those not at high risk

Stratospheric aerosol data records for the climate change initiative : Development, validation and application to chemistry-climate modelling

This paper presents stratospheric aerosol climate records developed in the framework of the Aerosol_cci project, one of the 14 parallel projects from the ESA Climate Change Initiative. These data records were processed from a stratospheric aerosol dataset derived from the GOMOS experiment, using an inversion algorithm optimized for aerosol retrieval, called AerGOM. They provide a suite of aerosol parameters, such as the aerosol extinction coefficient at different wavelengths in the UV-visible range.The extinction record includes the total extinction as well as separate fields for liquid sulfate aerosols and polar stratospheric clouds (PSCs). Several additional fields (PSC flag, etc.) are also provided. The resulting stratospheric aerosol dataset, which spans the whole duration of the GOMOS mission (2002-2012), was validated using different reference datasets (lidar and balloon profiles). In the present paper, the emphasis is put on the extinction records. After a thorough analysis of the original AerGOM dataset, we describe the methodology used to construct the gridded CCI-GOMOS dataset and the resulting improvements on both the AerGOM algorithm and the binning procedure, in terms of spatio-temporal resolution, coverage and data quality. The extinction datasets were validated using lidar profiles from three ground-based stations (Mauna Loa, Garmisch-Partenkirchen, Dumont d'Urville). The median difference of the CCI-GOMOS (Level 3) extinction and ground-based lidar profiles is between similar to 15% and similar to 45% in the 16-21 km altitude range, depending on the considered site and aerosol type. The CCI-GOMOS dataset was subsequently used, together with a MIPAS SO2 time series, to update a volcanic eruption inventory published previously, thus providing a more comprehensive list of eruptions for the ENVISAT period (2002-2012). The number of quantified eruptions increases from 102 to 230 in the updated inventory. This new inventory was used to simulate the evolution of the global radiative forcing by application of the EMAC chemistry-climate model. Results of this simulation improve the agreement between modelled global radiative forcing of stratospheric aerosols at about 100 hPa compared to values estimated from observations. Medium eruptions like the ones of Soufriere Hills/Rabaul (2006), Sarychev (2009) and Nabro (2011) cause a forcing change from about -0.1 W/m(2) to -0.2 W/m(2). (C) 2017 The Authors. Published by Elsevier Inc.Peer reviewe

Protocol for a systematic review to identify and weight the indicators of risk of asthma exacerbations in children aged 5-12 years

No abstract available

Innovative transportable laboratories for Polar science

The Netherlands Organisation for Scientific Research and the British Antarctic Survey have built a transportable laboratory facility, named the Dirck Gerritsz Laboratory, to accommodate new scientific research on and from the westernAntarctic Peninsula. The design provides a flexible,modular, plug-and-play, innovative and sustainable laboratory setup. The docking station houses four 20-foot ISO standard high-cube containers, each of which contains a different laboratory. Special technological features were used to minimise the environmental impact. The four laboratory containers are flexible and can be installed and used as required, and renewed or removedwhen necessary. The container laboratories have provided, since opening in 2013, enhanced facilities for global climate change research through studying the community composition of phytoplankton; the ecological impact of virus-induced mortality in different phytoplankton groups; dimethylsulphide and brominated compound fluxes; and CO2 concentrations and trace elements in sea water. Transportable research laboratory facilities provide an effective and efficient approach for undertaking scientific research in challenging environments and might be the start of a new way of undertaking research, including exchanging laboratory modules between research stations in Antarctica

At-risk children with asthma (ARC): a systematic review

INTRODUCTION: Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5-12 years) in order to inform and prioritise care. METHODS: We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop. RESULTS: From 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk. DISCUSSION: Assessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives. TRIAL REGISTRATION NUMBER: CRD42016037464