Adipokinetic hormone enhances laminarin and bacterial lipopolysaccharide-induced activation of the prophenoloxidase cascade in the African migratory locust, Locusta migratoria

Lom-AKH-I enhances the activation in vivo of prophenoloxidase in the haemolymph of the African migratory locust, Locusta migratoria, in response to challenge with laminarin. AKH does not influence the speed or initial magnitude of the phenoloxidase response to laminarin, but prolongs the period of activation of the enzyme in a dose-dependent manner. Injections of preparations of bacterial lipopolysaccharide (LPS) do not activate prophenoloxidase in vivo, but co-injection of Lom-AKH-I with commercial preparations of LPS from Klebsiella pneumoniae, Escherichia coli, or Shigella flexneri (but not one from Pseudomonas aeroginosa) results in dose-dependent increases in the levels of phenoloxidase that persist in the haemolymph for several hours. It is argued that the effects of AKH on phenoloxidase activation in locusts described here are, at least in part, related directly to changes in lipid metabolism brought about by the hormone

Novel application of a discrete choice experiment to identify preferences for a national healthcare-associated infection surveillance programme: a cross-sectional study

Objective: To identify key stakeholder preferences andpriorities when considering a national healthcareassociatedinfection (HAI) surveillance programmethrough the use of a discrete choice experiment (DCE).Setting: Australia does not have a national HAIsurveillance programme. An online web-based DCE wasdeveloped and made available to participants in Australia.Participants: A sample of 184 purposively selectedhealthcare workers based on their senior leadershiprole in infection prevention in Australia.Primary and secondary outcomes: A DCErequiring respondents to select 1 HAI surveillanceprogramme over another based on 5 differentcharacteristics (or attributes) in repeated hypotheticalscenarios. Data were analysed using a mixed logitmodel to evaluate preferences and identify the relativeimportance of each attribute.Results: A total of 122 participants completed thesurvey (response rate 66%) over a 5-week period.Excluding 22 who mismatched a duplicate choicescenario, analysis was conducted on 100 responses.The key findings included: 72% of stakeholdersexhibited a preference for a surveillance programmewith continuous mandatory core components (meancoefficient 0.640 ( p<0.01)), 65% for a standardsurveillance protocol where patient-level data arecollected on infected and non-infected patients (meancoefficient 0.641 ( p<0.01)), and 92% for hospital-leveldata that are publicly reported on a website and notassociated with financial penalties (mean coefficient1.663 ( p<0.01)).Conclusions: The use of the DCE has provided aunique insight to key stakeholder priorities whenconsidering a national HAI surveillance programme.The application of a DCE offers a meaningful methodto explore and quantify preferences in this setting

Vaccination with Ad5 Vectors Expands Ad5-Specific CD8+ T Cells without Altering Memory Phenotype or Functionality

Adenoviral (Ad) vaccine vectors represent both a vehicle to present a novel antigen to the immune system as well as restimulation of immune responses against the Ad vector itself. To what degree Ad-specific CD8(+) T cells are restimulated by Ad vector vaccination is unclear, although such knowledge would be important as vector-specific CD8(+) T cell expansion could potentially further limit Ad vaccine efficacy beyond Ad-specific neutralizing antibody alone.Here we addressed this issue by measuring human Adenovirus serotype 5 (Ad5)-specific CD8(+) T cells in recipients of the Merck Ad5 HIV-1 vaccine vector before, during, and after vaccination by multicolor flow cytometry. Ad5-specific CD8(+) T-cells were detectable in 95% of subjects prior to vaccination, and displayed primarily an effector-type functional profile and phenotype. Peripheral blood Ad5-specific CD8(+) T-cell numbers expanded after Ad5-HIV vaccination in all subjects, but differential expansion kinetics were noted in some baseline Ad5-neutralizing antibody (Ad5 nAb) seronegative subjects compared to baseline Ad5 nAb seropositive subjects. However, in neither group did vaccination alter polyfunctionality, mucosal targeting marker expression, or memory phenotype of Ad5-specific CD8(+) T-cells.These data indicate that repeat Ad5-vector administration in humans expands Ad5-specific CD8(+) T-cells without overtly affecting their functional capacity or phenotypic properties. This is a secondary analysis of samples collected during the 016 trial. Results of the Merck 016 trial safety and immunogenicity have been previously published in the journal of clinical infectious diseases [1].ClinicalTrials.gov NCT00849680[http://www.clinicaltrials.gov/show/NCT00849680]

Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review [version 3; referees: 2 approved]

Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout

Routine activities and proactive police activity: a macro-scale analysis of police searches in London and New York City

This paper explored how city-level changes in routine activities were associated with changes in frequencies of police searches using six years of police records from the London Metropolitan Police Service and the New York City Police Department. Routine activities were operationalised through selecting events that potentially impacted on (a) the street population, (b) the frequency of crime or (c) the level of police activity. OLS regression results indicated that routine activity variables (e.g. day of the week, periods of high demand for police service) can explain a large proportion of the variance in search frequency throughout the year. A complex set of results emerged, revealing cross-national dissimilarities and the differential impact of certain activities (e.g. public holidays). Importantly, temporal frequencies in searches are not reducible to associations between searches and recorded street crime, nor changes in on-street population. Based on the routine activity approach, a theoretical police-action model is proposed

PHC Progression Model: A novel mixed-methods tool for measuring primary health care system capacity

High-performing primary health care (PHC) is essential for achieving universal health coverage. However, in many countries, PHC is weak and unable to deliver on its potential. Improvement is often limited by a lack of actionable data to inform policies and set priorities. To address this gap, the Primary Health Care Performance Initiative (PHCPI) was formed to strengthen measurement of PHC in low-income and middle-income countries in order to accelerate improvement. PHCPI´s Vital Signs Profile was designed to provide a comprehensive snapshot of the performance of a country´s PHC system, yet quantitative information about PHC systems´ capacity to deliver high-quality, effective care was limited by the scarcity of existing data sources and metrics. To systematically measure the capacity of PHC systems, PHCPI developed the PHC Progression Model, a rubric-based mixed-methods assessment tool. The PHC Progression Model is completed through a participatory process by in-country teams and subsequently reviewed by PHCPI to validate results and ensure consistency across countries. In 2018, PHCPI partnered with five countries to pilot the tool and found that it was feasible to implement with fidelity, produced valid results, and was highly acceptable and useful to stakeholders. Pilot results showed that both the participatory assessment process and resulting findings yielded novel and actionable insights into PHC strengths and weaknesses. Based on these positive early results, PHCPI will support expansion of the PHC Progression Model to additional countries to systematically and comprehensively measure PHC system capacity in order to identify and prioritise targeted improvement efforts.Fil: Ratcliffe, Hannah L.. Brigham And Women's Hospital; Estados Unidos. Harvard T.H. Chan School of Public Health; Estados UnidosFil: Schwarz, Dan. Harvard T.H. Chan School of Public Health; Estados Unidos. Brigham And Women's Hospital; Estados UnidosFil: Hirschhorn, Lisa R.. Northwestern University; Estados UnidosFil: Cejas, Cintia. Ministerio de Desarrollo Social; Argentina. Ministerio de Salud de la Nación; ArgentinaFil: DIallo, Abdoulaye. Ministry Of Health And Social Action; SenegalFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Fifield, Jocelyn. Brigham And Women's Hospital; Estados Unidos. Harvard T.H. Chan School of Public Health; Estados UnidosFil: Gashumba, DIane. Ministry of Health; RuandaFil: Hartshorn, Lucy. Harvard T.H. Chan School of Public Health; Estados Unidos. Brigham And Women's Hospital; Estados UnidosFil: Leydon, Nicholas. Bill And Melinda Gates Foundation; Estados UnidosFil: Mohamed, Mohamed. Ministry Of Health And Social Welfare Dar Es Salaam; TanzaniaFil: Nakamura, Yoriko. Results For Development; Estados UnidosFil: Ndiaye, Youssoupha. Ministry Of Health And Social Action; SenegalFil: Novignon, Jacob. Kwame Nkrumah University Of Science And Technology; GhanaFil: Ofosu, Anthony. Ghana Health Service; GhanaFil: Roder Dewan, Sanam. Organización de las Naciones Unidas. Unicef. Fondo de las Naciones Unidas para la Infancia; ArgentinaFil: Rwiyereka, Angelique. Global Health Issues and Solutions; Estados UnidosFil: Secci, Federica. The World Bank Group; Estados UnidosFil: Veillard, Jeremy H.. The World Bank Group; Estados UnidosFil: Bitton, Asaf. Harvard T.H. Chan School of Public Health; Estados Unidos. Brigham And Women's Hospital; Estados Unido

A Framework for the practical application of the concepts of critical natural capital and strong sustainability

This paper develops a methodology for identifying that natural capital—called critical natural capital (CNC)—the maintenance of which is essential for environmental sustainability. By consideration of the characteristics of natural capital, of the environmental functions that these characteristics enable natural capital to perform and of the importance of these functions to humans and the biosphere, it shows how sustainability standards in respect of these environmental functions may be derived. The difference between the current situation and these standards is termed the sustainability gap. The methodology that emerges from bringing these ideas together into a single analytical framework enables policy makers to identify the extent of current unsustainability, the principal causes of it, the elements and processes of natural capital (the CNC) which need to be maintained or restored to close the sustainability gap and the costs of so doing. The framework should therefore be of use in identifying priorities and policies for moving towards environmental sustainability

Scenario planning: the future of the cattle and sheep industries in Scotland and their resiliency to disease

In this paper, we present a description of foresighting activities undertaken by EPIC, Scotland’s Centre of Expertise on Animal Disease Outbreaks, to investigate the future uncertainty of animal health security in the Scottish sheep and cattle sectors. Using scenario planning methodologies, we explored four plausible but provocative long-term futures which identify dynamics underpinning the resilience of these agricultural sectors to animal disease. These scenarios highlight a number of important drivers that influence disease resilience: industry demographics, the role of government support and regulation and the capacity for technological innovation to support the industry to meet local and global market demand. Participants in the scenario planning exercises proposed creative, robust strategies that policy makers could consider implementing now to enhance disease control and industry resilience in multiple, uncertain futures. Using these participant-led strategies as a starting point, we offer ten key questions for policy makers and stakeholders to provoke further discussion about improving resiliency and disease preparedness. We conclude with a brief discussion of the value of scenario planning, not only for the development of futures which will inform disease contingency plans and improve industry resilience, but as a mechanism for dialogue and information sharing between stakeholders and government