Towards a Global System of Innovation: the Role of Donors in Immunisation for International Development

This research examines what role donors play with respect to innovation in immunisation for international development. It uses as its conceptual framework the global innovation system (GIS) model to examine the principal donors within the sector. Because the empirical data is in-depth, contextualised, and qualitative, the research design adopted is that of a multiple case-study of donor organisations, using triangulated, mixed-methods qualitative data collection. The examined cases are UNICEF, the Bill and Melinda Gates Foundation, and Gavi, the Vaccine Alliance. Knowledge gaps in the existing literature related to how these donors engage actors and institutions across different spatial levels for innovation; to how donors’ manifold power relations affect this; and to how donor structure and capabilities determine their particular roles in innovation. The research finds strong evidence of an emerging GIS in immunisation for international development. This consists of a global sub-system and a set of sub-systems at the national level, each representing a country receiving development assistance in immunisation. Donors perform four principal roles within this GIS. Firstly, they provide, maintain and extend structural elements of the GIS, especially its networks and linkages between sub-systems. Secondly, donors generate and utilise resources of financial investment, market access and innovation legitimacy for the valuation of innovation. Thirdly, donors coordinate to ensure complementarity in the activities they and other actors provide, which enables effective distributed agency across the GIS. Fourthly, donors navigate the rules, norms and presumptions of the GIS on behalf of partnerships of actors, variously complying, co-opting or contesting them. The relationship is shown between each of these principal roles and the system’s spatial levels, inter-actor power relations and donors’ structure and capabilities. This offers new, detailed understanding to close significantly the previously-identified knowledge gaps

Military Ethics Education – What Is It, How Should It Be Done, and Why Is It Important?

This paper explores the topic of military ethics, what we mean by that term, what it covers, how it is understood, and how it is taught. It suggests that the unifying factor that makes this a coherent subject beyond individual national interpretations of it is the core idea of military professionalism. The paper draws out the distinction between training and education and draws on research conducted by a number of different people and agencies, including the International Committee of the Red Cross, to establish what factors contribute to effective pedagogy and the inculcation of appropriate attitudes and behaviours. The paper concludes by looking at the way military ethics contributes to military outcomes from protecting civilians and the vulnerable to building resilience in our own military personnel to protect their mental health, through to the strategic costs of losing the moral high ground if behaviour is seen to fall short of that expected from military professionals

Safe Injection Sites versus Street Use: Preventing Fatal Overdoses, Disease Transmission, and Hospitalization

The opioid crisis is continuing to rise. Safe injection sites (SIS) have been introduced to help mitigate harm with intravenous drug use. Utilizing current literature, the goal is to discover the correlation between the implementation of SIS and their results on overall fatal overdoses, disease transmission, and hospitalization rates compared to intravenous drug users without access to a SIS. A literature search was conducted utilizing CINAHL, PubMed, Nursing Reference Center Plus, and Google Scholar using the following search terms: safe injection site*, harm reduction, overdose, hospitalization*, opposition. A total of 204 articles met the inclusion criteria. The exclusion criteria included: individuals currently going through substance abuse treatments, individuals currently receiving pharmacological therapies for drug dependency, and unsanctioned safe injection sites. Inclusion and exclusion criteria yielded 10 articles. The evidence was mixed for the usage of SIS. More literature was in favor of the utilization of SIS. The literature found that individuals with access to an SIS had increased access to healthcare professionals equipped with Naloxone, pulse oximetry, and supplemental oxygen to reduce fatal overdoses. Lastly, due to the intimate nature of the SIS, rapport is gained, allowing for potential referrals to seek substance abuse treatment. Limitations of this review include SIS being relatively new in the United States therefore there needs to be more research conducted. Based on these findings, there is a strong correlation that the implementation of SIS effectively reduces disease transmission, prevents emergency department visits, reduces hospitalization stays, and decreases overall mortality due to intravenous drug use

Treatment of mild-to-moderate pelvic inflammatory disease with a short-course azithromycin-based regimen versus ofloxacin plus metronidazole: results of a multicentre, randomised controlled trial

OBJECTIVE: A multicentre, randomised non-inferiority trial compared the efficacy and safety of 14 days of ofloxacin and metronidazole (standard-of-care (SoC)) versus a single dose of intramuscular ceftriaxone followed by 5 days of azithromycin and metronidazole (intervention arm (IA)) in women with mild-to-moderate pelvic inflammatory disease (PID). METHODS: Women with a clinical diagnosis of PID presenting at sexual health services were randomised to the SoC or IA arms. Treating clinicians and participants were not blinded to treatment allocation but the clinician performing the assessment of primary outcome was blinded. The primary outcome was clinical cure defined as ≥70% reduction in the modified McCormack pain score at day 14-21 after starting treatment. Secondary outcomes included adherence, tolerability and microbiological cure. RESULTS: Of the randomised population 72/153 (47.1%) reached the primary end point in the SoC arm, compared with 68/160 (42.5%) in the IA (difference in cure 4.6% (95% CI -15.6% to 6.5%). Following exclusion of 86 women who were lost to follow-up, attended outside the day 14-21 follow-up period, or withdrew consent, 72/107 (67.3%) had clinical cure in the SoC arm compared with 68/120 (56.7%) in the IA, giving a difference in cure rate of 10.6% (95% CI -23.2% to 1.9%). We were unable to demonstrate non-inferiority of the IA compared with SoC arm. Women in the IA took more treatment doses compared with the SoC group (113/124 (91%) vs 75/117 (64%), p=0.0001), but were more likely to experience diarrhoea (61% vs 24%, p<0.0001). Of 288 samples available for analysis, Mycoplasma genitalium was identified in 10% (28/288), 58% (11/19) of which had baseline antimicrobial resistance-associated mutations. CONCLUSION: A short-course azithromycin-based regimen is likely to be less effective than the standard treatment with ofloxacin plus metronidazole. The high rate of baseline antimicrobial resistance supports resistance testing in those with M. genitalium infection to guide appropriate therapy. TRIAL REGISTRATION NUMBER: 2010-023254-36