Clean birth kits to improve birth practices: development and testing of a country level decision support tool

Background: Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth. Methods: Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group. Results: The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented. Conclusion: Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs

Improving energy efficiency in private rented housing : what makes landlords act?

The private rented sector in England contains some of the least energy efficient properties in the country and houses more vulnerable households than any other sector. Occupants endure dangerously cold homes and fuel poverty but have no direct influence over the energy performance of their homes. The choices that occupants make regarding energy are constrained by the material characteristics of a property: something only the landlord can alter. Enduringly poor conditions in the sector indicate that an initiative that convinces landlords of the benefits of improving energy efficiency remains elusive. Based on a review of existing research and 30 interviews with landlords, this paper identifies factors which deter landlords from acting to improve energy efficiency. Factors include lack of knowledge regarding the consequences of energy inefficiency and possible solutions, the absence of direct financial incentives (the principal–agent problem), local housing market and cultural factors. It also identifies a number of motivating factors that may encourage landlords to invest in energy efficiency. It is argued that policies to tackle energy inefficiency in the sector should take account of these factors in order to improve effectiveness. Keywords Private rented sector, Domestic energy efficiency, Principal–agent, The Green Deal, Private landlords, Split incentiv

A Review of Drowning Prevention Interventions for Children and Young People in High, Low and Middle Income Countries.

Globally, drowning is one of the ten leading causes of child mortality. Children aged <5 years are particularly at risk, and children and young people continue to be overrepresented in drowning statistics. Accordingly, evidence informed interventions to prevent children drowning are of global importance. This review aimed to identify, assess and analyse public health interventions to reduce child drowning and investigate the use of behavioural theories and evaluation frameworks to guide child drowning prevention. Thirteen databases were searched for relevant peer reviewed articles. The systematic review was guided by the PRISMA criteria and registered with PROSPERO. Fifteen articles were included in the final review. Studies were delivered in high, middle and low income countries. Intervention designs varied, one-third of studies targeted children under five. Almost half of the studies relied on education and information to reduce drowning deaths, only three studies used a multi-strategy approach. Minimal use of behavioural theories and/or frameworks was found and just one-third of the studies described formative evaluation. This review reveals an over reliance on education and information as a strategy to prevent drowning, despite evidence for comprehensive multi-strategy approaches. Accordingly, interventions must be supported that use a range of strategies, are shaped by theory and planning and evaluation frameworks, and are robust in intervention design, delivery and evaluation methodology. This approach will provide sound evidence that can be disseminated to inform future practice and policy for drowning prevention

How moving home influences appliance ownership: a Passivhaus case study

Low carbon dwellings shift the focus to electricity consumption and appliances by significantly lowering space heating energy consumption. Using a UK Passivhaus (low carbon) case study, interviews and pre/post-move-in appliance audits were employed to investigate how moving home can change the appliance requirements of appliance-using practices. Changes in appliance ownership were due to differences in how appliance-using practices (e.g. cooking, laundering, homemaking) were being performed. Existing/new appliances complemented/conflicted with a new home on the basis of whether the social meanings of specific appliance-using practices (e.g. stylishness, convenience, thermal comfort, cleanliness) could be met. This was evident, when moving home more generally, by households buying new modern appliances and managing spatial constraints. More specifically, regarding Passivhaus, hosting and homemaking practices were performed in ways that met thermal comfort expectations, in addition to appliance purchasing also being influenced by a fear that the Passivhaus technologies could fail. Whilst skills and competences were needed to perform appliance-using practices, these were less prominent in influencing appliance ownership changes. Conclusions include reflections on how the elements of appliance-using practices change when moving home, as well as what adhering to building standards could mean for the standardisation of appliance-using practices and domestic life more generally

Addressing Recruitment Challenges in the Engage-HU Trial in Young Children with Sickle Cell Disease

Background: Sickle cell disease (SCD) is a genetic disorder that causes significant medical and neurologic morbidity in children. Hydroxyurea (HU) is the primary medication used to prevent these complications. National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend offering HU to children as young as 9 months of age with SCD (HbSS or HbSB0 thalassemia) using a shared decision-making approach. Although HU has proven efficacious it remains underutilized and caregivers report that they are not always actively involved in the decision to initiate this therapy. Reasons for limited HU uptake likely include lack of clinician knowledge and training and negative caregiver perceptions. Thus, we developed the Engage-HU trial as a novel approach to address HU utilization barriers. A critical consideration for this trial was that SCD primarily affects individuals of African and Hispanic/Latino descent. In these minority populations, intervention trials are sometimes terminated early because of recruitment difficulties related to mistrust of research, caregiver burden, and transportation issues. As such, the Engage-HU trial design included best-practice strategies for recruiting people of color in research. This study describes these strategies, the initial recruitment plan, preliminary recruitment outcomes and strategies, and our procedural adaptations. Study Design and Methods: Engage-HU is a randomized control trial (NCT03442114) to assess how clinicians can engage caregivers in a shared discussion that considers their values and preferences and includes evidence that supports HU. Engage-HU compares two dissemination methods for clinicians to facilitate shared decision-making with caregivers of young children with SCD: 1) the American Society of Hematology Pocket Guide, and 2) the HU Shared-Decision Making (H-SDM) Toolkit. The study aims to recruit 174 caregivers and evaluate the effectiveness of the dissemination methods on patient-centered outcomes (caregiver confidence in decision-making and perceptions of experiencing shared decision-making) as well as HU uptake and child health outcomes. Eligible children are aged 0 to 5 years, candidates for HU, and their caregiver has not made a decision about HU in the past 3 months. The trial is being conducted at 9 sites in the United States and uses a stepped-wedge design. Data will be analyzed based on the intent-to-treat principle. All participants will remain in the arm of the study to which they were randomized, regardless of whether or not they receive the assigned dissemination method. The primary endpoints are caregiver decisional uncertainty and caregiver perception of shared decision-making measured using validated tools. Data will be analyzed using a linear mixed effects regression model with a robust variance estimator and maximum likelihood estimation with observations clustered within site. The Engage-HU trial includes adaptations to increase recruitment such as tailored messaging, a relational recruitment approach, streamlined data collection, and a Stakeholder Advisory Committee. However, even with these adaptations, the first 6-months of the trial yielded lower than anticipated recruitment. Rather than terminate the trial or accept low enrollment, the research team implemented a series of recruitment strategies to address barriers including helping to improve research coordinator knowledge of the study purpose and adjusting no-show and follow-up procedures (e.g., calls to families after missed appointments and reminder calls before appointments). Site clinicians and clinic staff were provided with additional training so they could give more context about Engage-HU to caregivers and the study principal investigator led monthly "all coordinator" calls to provide support by sharing updates and experiences about successful recruitment. Implementation of these strategies resulted in triple the number of enrollments over the next 7-months compared to the previous 6-months (Table 1). Our goal in sharing this information is to provide lessons learned that can be implemented in future trials with the systematically underserved SCD population. It is also anticipated that methods described here may also inform clinical approaches to better engage caregivers of young children around critical clinical conversations, such as initiating medications like HU. Disclosures King: Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees; Bioline: Consultancy; RiverVest: Consultancy; Novimmune: Research Funding; Celgene: Consultancy; Tioma Therapuetics: Consultancy; Amphivena Therapeutics: Research Funding; WUGEN: Current equity holder in private company; Cell Works: Consultancy; Incyte: Consultancy. Smith-Whitley:Prime: Other: Education material; Celgene: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Neumayr:Emmaus: Consultancy; Bayer: Consultancy; CTD Holdings: Consultancy; Pfizer: Consultancy; ApoPharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Micelle: Other: Site principal investigator; GBT: Other: Site principal investigator; PCORI: Other: site principal investigator; Novartis: Other: co-investigator; Bluebird Bio: Other: co-investigator; Sangamo Therapeutics: Other; Silarus: Other; Celgene: Other; La Jolla Pharmaceuticals: Other; Forma: Other; Imara: Other; National Heart, Lung, and Blood Institute: Other; Health Resources and Services Administration: Other; Centers for Disease Control and Prevention: Other; Seattle Children's Research: Other. Yates:Novartis: Research Funding. Thompson:Novartis: Consultancy, Honoraria, Research Funding; CRISPR/Vertex: Research Funding; BMS: Consultancy, Research Funding; Baxalta: Research Funding; Biomarin: Research Funding; bluebird bio, Inc.: Consultancy, Research Funding. </jats:sec

United Nations Sustainable Development Goals: Promoting health and well-being through physical education partnerships

The United Nations recently approved the Sustainable Development Goals (SDGs) which forms a guideline policy for all nations. While the UN have strongly advised that partnerships are essential for the implementation of these global goals, within local communities there is little evidence of how this is best done or what it looks like in practice. This paper shares a health and wellbeing community initiative that achieves goals three and four of the SDGs, and in doing so models how to implement physical education partnerships as advocated by the UN. The highly successful innovative initiative is “Best Start: A community collaborative approach to lifelong health and wellness” (2011–2014).This paper shares a health and wellbeing partnership, modelling implementation of physical education (PE) advocated by the United Nations (UN). The Sustainable Development Goals (SDGs) exemplifies global efforts towards equality, specifically Goal 3 and 4 address health and wellbeing. The purpose of this paper is to provide insights into cross sector “partnerships”, identified as essential for the implementation of the SDGs. This is significant as the UN acknowledge a present gap of information on partnerships in action and a need for reporting from the ground level. The project “Best Start: A community collaborative approach to lifelong health and wellness”, began as a partnership between a university and nearby schools and quickly grew to involve Australian Registered Training Organisations, the local health industry, Education departments and sport governing bodies. The collaborations involved pre-service teachers teaching Health and PE lessons to children in a disadvantaged socio-economic area, creating valuable learning experiences for stakeholders. Local and global communities were involved in research and reform. The project creatively optimised resources available through state, Australian and international connections. International partnerships enabled identification of unique contextual opportunities. Programme planning was strengthened with data gathered from an England and Wales Ofsted awarded Primary Physical Education course. Various methods, including; semi-structured interviews, reflective journal, observations, document analysis, and Student Evaluation of Teaching Units (SETU) were adopted. SETU is valid and reliable data collected by the university for the purposes of research. The findings support that partnerships enable SDG implementation and the research paper offers direction for localisation

Internationalised banking, alternative banks and the Single Supervisory Mechanism

This paper sets out to explain the preferences of the seven northern euro area member states on the Single Supervisory Mechanism (SSM) concerning the threshold set for direct European Central Bank (ECB) control over bank supervision. Building on the concept of the ‘financial trilemma’, it argues that different bank internationalisation patterns in the seven northern member states explain different preferences on the transfer of supervisory powers over less significant banks to the ECB. In particular, the reach of internationalisation into a national banking system – notably the extent to which even smaller banks were exposed to foreign banking operations – is shown to be the core factor explaining different national preferences on threshold. In the five countries with a large number of small and parochial alternative (cooperative and savings) banks, it is necessary to examine the system-specific structures of these banks to explain better the reach of internationalisation and national preferences on the threshold. Determined German opposition to ECB supervision of smaller alternative banks is juxtaposed with either less hostile or more positive support of at least four other countries despite the important presence of small alternative banks

Mineral composition of wild relatives and introgressive forms in wheat selection

The study of seed mineral composition of wheat and its wild relatives revealed higher content of all elements in Aegilops ovata and Ae. triuncialis, as well as an overall increased background in relatives compared to modern varieties of Triticum aestivum (standards). By content of macro- and microelements, synthetic forms of wheat occupy an intermediate position between wild relatives and modern varieties. Transitional forms with the level of mineral composition typical of wild forms (Zhetysu x T militinae; Zhetysu x T kiharae; Bezostaya 1 x Ae. cylindrica) have been identified. All genotypes have been differentiated into 3 clusters. The first consists predominantly of introgressive forms, Ae. triaristata and the Komsomolskaya 1 variety, which has wild forms in its origin. The second cluster includes mainly varieties (parental forms), T. timopheevii and the introgressive form (Steklovidnaya 24 x T militinae). The third cluster consists largely of T. militinae, T. kiharae, Ae. cylindrica species and introgressive forms originated from them: Zhetysu x T militinae and Bezostaya 1 x Ae. cylindrica. Such division allows us to classify genotypes according to the level of metabolism: wild relatives (3rd cluster), varieties (2nd cluster) and an intermediate group - introgressive forms (1st cluster). In general, inclusion of cultural forms (backcrossing with varieties) to crosses with introgressive forms is usually accompanied by a decrease in the total metabolic level, but it varies in cultivars and wild species characterized by polymorphism. Sources of high content of elements have been revealed: wild relatives and introgressive forms, some of which are donors. According to the results of topcross breeding with testers - commercial common wheat varieties Steklovidnaya 24, Almali, Zhetysu - inheritance of this trait by progenies in F-2-F-3 generations has been revealed in two constant lines: (Bezostaya 1 x Ae. cylindrica) x T kiharae and Zhetysu x T kiharae