Factors That Influence Data Use to Improve Health Service Delivery in Low- and Middle-Income Countries

Background: Health service delivery indicators are designed to reveal how well health services meet a community's needs. Effective use of the data can enable targeted improvements in health service delivery. We conducted a systematic review to identify the factors that influence the use of health service delivery indicators to improve delivery of primary health care services in low- and middle-income settings. Methods: We reviewed empirical studies published in 2005 or later that provided evidence on the use of health service delivery data at the primary care level in low- and middle-income countries. We searched Scopus, Medline, the Cochrane Library, and citations of included studies. We also searched the gray literature, using a separate strategy. We extracted information on study design, setting, study population, study objective, key findings, and any identified lessons learned. Results: Twelve studies met the inclusion criteria. This small number of studies suggests there is insufficient evidence to draw reliable conclusions. However, a content analysis identified the following potentially influential factors, which we classified into 3 categories: governance (leadership, participatory monitoring, regular review of data); production of information (presentation of findings, data quality, qualitative data); and health information system resources (electronic health management information systems, organizational structure, training). Contextual factors and performance-based financing were also each found to have a role; however, discussing these as mediating factors may not be practical in terms of promoting data use. Conclusion: Scant evidence exists regarding factors that influence the use of health service delivery indicators to improve delivery of primary health care services in low- and middle-income countries. However, the existing evidence highlights some factors that may have a role in improving data use. Further research may benefit from comparing data use factors across different types of program indicators or using our classification as a framework for field experiments.This research is supported by an Australian Government Research Training Program Fee Offset Scholarship

Open Networking Lab: online practical learning of computer networking

Learning to configure computer networks is a topic requiring a substantial practical component and suggesting a pedagogic approach that foregrounds experiential learning. However, providing appropriate computer networking hardware is expensive for classroom labs, and is not viable for individual distance learners. Simulation offers an alternative basis for practical learning and supports a range of modes, from individual distance learning to in-class blended learning. Sophisticated network simulation packages, such as Cisco’s Packet Tracer, have high fidelity to networking devices and can simulate complex network scenarios. Unfortunately their complex interfaces make it difficult for a novice student to engage productively. The Open Networking Lab (ONL) will provide online resources for students of introductory computer networking. It will take an activity-centred approach, supported with video and screencasts, in preference to lengthy text. Practical activity is based on PT Anywhere, a network simulator that provides students with an easy-to-use, browser-based interface over Cisco’s Packet Tracer. PT Anywhere thus provides fully authentic simulation but, by only revealing a subset of features, supports a carefully scaffolded approach to teaching and learning. We report at an early stage in the development of the ONL. Material is being piloted with students at UK Further Education colleges. Evaluation will include observation, surveys and interviews with students and staff; PT Anywhere also provides learning analytics. A further stage of development will culminate in a badged open course on the Open University’s OpenLearn platform. The ONL will provide vocational learning at scale in educational institutions, employment contexts and for individual learners

The Open Networking Lab: Hands-on Vocational Learning in Computer Networking

An increasingly connected society demands people who can design, set up, monitor and maintain networks of computers and devices. Traditional classroom instruction cannot keep pace with demand, and networking hardware costs can be too high for widespread classroom use. This paper presents the Open Networking Lab, a new UK initiative for supporting hands-on vocational learning in computer networking. The Open Networking Lab will facilitate the development of introductory practical networking skills without using hardware, through the provision of a web-based network simulation package integrated into learning resources and activities. These learning resources will be evaluated by students and lecturers from a cluster of Further Education colleges in the UK and will subsequently be made available to learners worldwide via free and open courseware

Treating and Preventing Influenza in Aged Care Facilities: A Cluster Randomised Controlled Trial

PMCID: PMC3474842This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Shigella spp. Antimicrobial Drug Resistance, Papua New Guinea, 2000–2009

Approximately half the Shigella spp. infections in developing countries are caused by endemic shigellae (1), which in these countries are responsible for ¡Ö10% of all episodes of diarrhea among childre

An Open Networking Lab for practical open education

The Cisco Networking Academy programme (NetAcad) supports education and training in network engineering worldwide. NetAcad works with diverse educational institutions to offer an educational ‘vertical’ from beginner to advanced network engineer. However, as recognised by employment stakeholders, skills shortages in networking remain (Tech Partnership, 2016), particularly at the entry point (vocational levels two/three). NetAcad has been seen as a closed community based on the use of proprietary (Cisco) technology, but since 2013 it has moved towards openness through the release of APIs, free-to-use software/content, and the adoption of open standards. This has been, in part, enabled via scalable engagement projects with diverse stakeholders, including the UK Open University (OU). The OU is an Academy Support Centre (ASC) within NetAcad, supporting the growth and academic development of network engineering. In collaboration with Cisco and funded by the Ufi Charitable Trust, the OU is developing an online Badged Open Course (BOC), as part of the Open Networking Lab project (onl.kmi.open.ac.uk). Using the OU’s OpenLearn Create educational platform (www.open.edu/openlearncreate) under a CC-BY-SA-NC licence, material from the course can be taken and reused. The BOC will provide what is colloquially described as ‘zero to hero’ learning in network engineering and represents approximately 24 hours of study over 8 weeks. The course, which is free and open to all, is aimed at post-16 learners and is intended for use both by individuals engaged in independent study and classroom-based learners. Early versions of the course have been used by a number of UK further education colleges over the past 12 months. These institutions have been using the course with students who are studying towards a vocational qualification but currently have little previous experience of networking. Drawing on Sfard (1998), who argued that acquisition and participation are both necessary for learning, the course is primarily a combination of screencasts (acquisition) followed by experience/practice (participation) with a web-based computer network simulator. With the use of an Open API, integration between Cisco’s freely available and powerful ‘Packet Tracer’ network simulator and any compatible browser is enabled. The web-based network simulator, known as ‘PT Anywhere’ (Mikroyannidis et al., 2017) offers an authentic experience of networking, while developing learners’ confidence. Students can put into immediate practice technological skills learned via the screencasts. Each new practical activity delivers a network with configurable components. Students can follow the instructions, as well as freely exploring the network – adding, removing or modifying components. We will present findings from two large-scale evaluations of different stages of the course development. These evaluations took place with FE colleges using the course, and include student surveys, observations, learning analytics and interviews with staff. We will consider how these findings have shaped the development of the course as it moves towards becoming a BOC, hosted on the OU’s OpenLearn platform (www.open.edu/openlearn) and also accessible via the OU’s OpenSTEM Labs (stem.open.ac.uk/study/openstem-labs). We will discuss with participants the implications of being open to a range of learners with different learning preferences, learning needs and prior experience. References Kolb, D.A. (1984) Experiential Learning: Experience as the Source of Learning and Development. Prentice-Hall Inc., New Jersey. Mikroyannidis, A., Gomez-Goiri, A., Smith, A. & Domingue, J. (2017) Online Experimentation and Interactive Learning Resources for Teaching Network Engineering. IEEE Global Engineering Education Conference (EDUCON). Athens, Greece http://oro.open.ac.uk/49733/, IEEE Education Society Publications. Sfard, A. (1998). On Two Metaphors for Learning and the Dangers of Choosing just One. Educational Researcher, Vol. 27, No. 2, pp.4-13 Tech Partnership (2016). Factsheet: Demand for Digital specialists [online]. Available at:https://www.tpdegrees.com/globalassets/pdfs/research-2016/factsheet_demandfordigitalspecialists_july16.pdf. [Accessed 30 November 2018]

First reported outbreak of locally acquired hepatitis E virus infection in Australia

Objective: To determine the source and extent of a locally acquired hepatitis E virus (HEV) infection outbreak. Design, setting and participants: A cluster of notified cases of HEV infection linked to a single restaurant (X) was identified in May 2014. People with laboratory-confirmed HEV infection in New South Wales between January 2013 and December 2014 were interviewed about potential risk factors for HEV infection. Co-diners at restaurant X and patients with suspected but unexplained viral hepatitis were retrospectively tested. Foods eaten by the infected persons were compared with those of seronegative co-diners. HEV RNA detected in sera from infected persons was sequenced and genotyped. Implicated foods were traced back to their sources. Main outcome measures: Potential sources of infection, including overseas travel and foods eaten, and origin of implicated food products. Results: In 55 serologically confirmed cases of HEV infection, 24 people had not travelled overseas during their incubation periods. Of the 24, 17 reported having eaten at restaurant X, 15 of whom could be interviewed. All reported consuming pork liver pâté, compared with only four of seven uninfected co-diners (P < 0.05). The other seven people with locally acquired infections each reported consuming a pork product during their incubation periods. HEV RNA was detected in 16 of the 24 cases; all were of genotype 3. Sequencing indicated greater than 99% homology among restaurant X isolates. HEV RNA was isolated from pork sausages from a batch implicated in one of the locally acquired infections not linked with restaurant X. The pork livers used for pâté preparation by restaurant X were traced to a single Australian farm. Conclusions: This is the first reported HEV outbreak in Australia. HEV should be considered in patients presenting with a compatible illness, even without a history of overseas travel. Pork products should be thoroughly cooked before consumption

Spatio-temporal epidemiology of the cholera outbreak in Papua New Guinea, 2009-2011

Background: Cholera continues to be a devastating disease in many developing countries where inadequate safe water supply and poor sanitation facilitate spread. From July 2009 until late 2011 Papua New Guinea experienced the first outbreak of cholera recorded in the country, resulting in > 15,500 cases and > 500 deaths. Methods: Using the national cholera database, we analysed the spatio-temporal distribution and clustering of the Papua New Guinea cholera outbreak. The Kulldorff space-time permutation scan statistic, contained in the software package SatScan v9.2 was used to describe the first 8 weeks of the outbreak in Morobe Province before cholera cases spread throughout other regions of the country. Data were aggregated at the provincial level to describe the spread of the disease to other affected provinces. Results: Spatio-temporal and cluster analyses revealed that the outbreak was characterized by three distinct phases punctuated by explosive propagation of cases when the outbreak spread to a new region. The lack of road networks across most of Papua New Guinea is likely to have had a major influence on the slow spread of the disease during this outbreak. Conclusions: Identification of high risk areas and the likely mode of spread can guide government health authorities to formulate public health strategies to mitigate the spread of the disease through education campaigns, vaccination, increased surveillance in targeted areas and interventions to improve water, sanitation and hygiene

Gene therapy for monogenic liver diseases: clinical successes, current challenges and future prospects

Over the last decade, pioneering liver-directed gene therapy trials for haemophilia B have achieved sustained clinical improvement after a single systemic injection of adeno-associated virus (AAV) derived vectors encoding the human factor IX cDNA. These trials demonstrate the potential of AAV technology to provide long-lasting clinical benefit in the treatment of monogenic liver disorders. Indeed, with more than ten ongoing or planned clinical trials for haemophilia A and B and dozens of trials planned for other inherited genetic/metabolic liver diseases, clinical translation is expanding rapidly. Gene therapy is likely to become an option for routine care of a subset of severe inherited genetic/metabolic liver diseases in the relatively near term. In this review, we aim to summarise the milestones in the development of gene therapy, present the different vector tools and their clinical applications for liver-directed gene therapy. AAV-derived vectors are emerging as the leading candidates for clinical translation of gene delivery to the liver. Therefore, we focus on clinical applications of AAV vectors in providing the most recent update on clinical outcomes of completed and ongoing gene therapy trials and comment on the current challenges that the field is facing for large-scale clinical translation. There is clearly an urgent need for more efficient therapies in many severe monogenic liver disorders, which will require careful risk-benefit analysis for each indication, especially in paediatrics