Paradigms of social aesthetics in Themne oral performance

As this study argues, aesthetic considerations also play a critical role in their deployment of multimedia to realize creativity and achieve artistic variation. It is in this way that oral artists elaborate and improvise during oral performances, thereby continuing to engage their audiences. Specifically, I will examine the social aesthetic paradigms of sociability, the physical setting of the performance, and the belief system or worldview of the Themne, and consider the ways in which these factors engender artistic variation and creativity. I will also consider the ramifications of social aesthetics and multimedia for the audiences' appreciation and interpretation of the oral performance. My social aesthetic inquiry will not focus on an analysis of story texts per se, but on the physical setting and sociocultural conventions of Themne storytelling practices. The focus is on aspects of social aesthetics that impinge on artistic variation and creativity in storytelling and on processes of active audience participation in the delivery and interpretation of oral performances. I hope that such an analysis of the Themne oral artist's ability to exploit the aesthetic resources of the performance setting will lend weight to calls for scholars to pay due attention to the uniqueness of each performance and to capture, transcribe, and translate the "externalities" of a given performance as deployed by the oral artist.

A systematic review of the impact of psychosocial factors on immunity: Implications for enhancing BCG response against tuberculosis.

Background: Tuberculosis (TB) remains an urgent global public health priority, causing 1.5 million deaths worldwide in 2018. There is evidence that psychosocial factors modulate immune function; however, how this may influence TB risk or BCG vaccine response, and whether this pathway can be modified through social protection, has not been investigated. This paper aims to: a) systematically review evidence of how psychosocial factors influence the expression of biomarkers of immunity, and b) apply this general evidence to propose plausible TB-specific pathways for future study. Methods: Papers reporting on the impact of psychosocial stressors on immune biomarkers in relation to infectious disease risk were identified through a search of the databases MEDLINE, PsycINFO, Global Health and PsycEXTRA alongside reference list and citation searching of key papers. Data extraction and critical appraisal were carried out using a standardised form. The findings were tabulated and synthesised narratively by infectious disease category, and used to propose plausible mechanisms for how psychosocial exposures might influence immune outcomes relevant to TB and BCG response. Results: 27,026 citations were identified, of which 51 met the inclusion criteria. The literature provides evidence of a relationship between psychosocial factors and immune biomarkers. While the direction and strength of associations is heterogenous, some overarching patterns emerged: adverse psychosocial factors (e.g. stress) were generally associated with compromised vaccine response and higher antibody titres to herpesviruses, and vice versa for positive psychosocial factors (e.g. social support). Conclusions: The evidence identifies pathways linking psychosocial factors and immune response: co-viral infection and immune suppression, both of which are potentially relevant to TB and BCG response. However, the heterogeneity in the strength and nature of the impact of psychosocial factors on immune function, and lack of research on the implications of this relationship for TB, underscore the need for TB-specific research

Studies to inform the development and practical roll-out of a digital adherence intervention, Video-Observed Therapy (VOT)

BACKGROUND: Prior to the COVID-19 pandemic, globally, tuberculosis (TB) was the leading cause of death from a single infectious agent. It is an important example of a curable condition which has well-documented treatment adherence challenges. WHO recommends the use of video-observed therapy (VOT) as a flexible alternative to DOT (Directly Observed Treatment). There is limited evidence of VOT’s acceptability and how it may enable patients to engage with their treatment to elicit optimal adherence outcomes. This PhD thesis aims to improve understanding of patient groups who may benefit most from VOT. METHODS: Drawing upon a narrative literature review, this PhD thesis includes: a) a study to identify factors that predict non-completion of TB treatment through a retrospective cohort analysis of cases with TB notified to the Enhanced TB Surveillance System in England, Wales and Northern Ireland between 2010 and 2017; b) a study comparing VOT to in-person DOT to examine the factors which affect the levels of engagement with DOT and VOT and whether these affect the level of treatment observation achieved in DOT and VOT groups through a secondary analysis of the UK DOT/VOT trial dataset using descriptive analysis and logistic regression; c) a qualitative study exploring the lived experiences and perspectives of DOT and VOT users in two settings, the UK and Republic of Moldova using semi-structured interviews with 16 UK DOT/VOT trial participants and 22 Moldovan DOT/VOT trial participants. Themes were mapped onto the Capability Opportunity Motivation Behaviour (COM-B) model, Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) to identify how the VOT and DOT functions, strategies and its policy categories elicit treatment adherence outcomes to support decision-making on commissioning of DOT and VOT interventions. RESULTS: Recent migration to the UK (0 -1 years from entry to the UK to TB notification), multidrug resistance, increasing social complexity and a previous TB diagnosis were significantly associated with non-completion of TB treatment. Higher levels of initial engagement with VOT (90% initially engaged) rather than DOT (49% initially engaged) were observed amongst all patient groups. Amongst those who initially engaged with either DOT or VOT, patients with TB on VOT had improved TB treatment adherence compared those on DOT. Women were less likely to adhere and those with a history of being lost to follow-up were also less likely to adhere. The COM-B model and TDF provided explanatory frameworks highlighting how VOT acted on key behaviour change domains and utilised key strategies to facilitate adherence behaviour change. VOT facilitated patient-provider interactions served as a prompt/reminder to address forgetfulness through regular personalised messages from VOT observers, building rapport and habit-forming practices. VOT was a flexible, time- and cost-saving alternative to DOT and supported patients with split dosing or negotiated timing of dosing to manage side effects and pill burden. VOT also served as an incentive through the provision of a smartphone and data plan, free domestic calls, text messages and internet access linking patients to providers, banking and social support services. In turn these ‘capability and ‘opportunity’ components of the model enhanced ‘motivation’ by supporting patients to re-gain autonomy, self-responsibility and establish regular dosing. There were mixed views on privacy with participants expressing concerns on how video clips would be used, shared and may compromise confidentiality and increase stigma. The Behaviour Change Wheel identified seven key functions (‘active ingredients’) of VOT: Enablement (increasing means/reducing barriers to increase capability), Education (increasing knowledge or understanding), Persuasion (using communication to induce positive or negative feelings or stimulate action), Training (imparting skills), Incentivisation (creating expectation of reward), Restriction (using rules to reduce opportunity to engage in target behaviour) and Environmental restructuring (changing the physical or social context). While participants on DOT felt cared for, they had doubts about their personal necessity for treatment, found DOT invasive and stigmatising, time-consuming and costly. At a health system level, DOT was resource-intensive and batch collections of medicines made it difficult to prove fidelity. CONCLUSION: VOT promotes engagement and adherence to TB treatment in all groups at risk of non-adherence, which suggest it is a more acceptable approach to TB treatment observation compared to DOT. VOT can be universally applied to all patient groups in need of adherence support, including inclusion health groups (those with a current or history of homelessness, imprisonment, drug misuse and current alcohol misuse, vulnerable migrant groups (asylum seekers and refugees), in low TB incidence settings. DOT is an acceptable intervention to some groups with multiple needs (participants who were aged over 55, had a prison history, a history of homelessness (more than 5 years ago) and those with current alcohol problems). The evidence from this research could be used to develop a personalised decision support tool to support clinicians to offer VOT to groups based on risk of poor adherence and quantitative and qualitative assessment of acceptability and engagement. Use of the e-Health Implementation Toolkit (e-HIT) supports the national and practical roll-out of VOT to all patient groups in need of adherence support, including those with social complexity. In the era of COVID-19 and acceleration of the use of digital innovations, monitoring the roll-out of VOT should also involve engagement with patients on privacy and confidentiality issues. Engagement with the TB workforce is needed to examine staff attitudes to support learning on what adaptations could be made to VOT and to inform their needs and health system readiness, strengthen health protection and global health security. Further engagement with healthcare professionals to secure their buy-in, address their concerns and to minimise “technology fatigue” is needed. VOT has shown that it improves treatment adherence and while trials are yet to provide convincing evidence to data that it enhances final outcomes, the technology itself does have the potential to reduce treatment-related costs at a patient and health service level. In 2020 WHO proposed VOT as one of the options to support adherence in its target product profiles for TB preventative treatment. Further real-world programmatic evidence on how VOT works and health system cost-effectiveness should continue to be conducted under different conditions of care, including in different geographical settings, patient sub-groups and at different stages of treatment. FUNDING: UCL discretionary funds, Royal Society of Tropical Medicine and Hygiene and UCL Public Policy small grant award

Calorimetry, activity, and micro-FTIR analysis of CO chemisorption, titration, and oxidation on supported Pt

The value of in situ analysis on CO chemisorption, titration and oxidation over supported Pt catalysts using calorimetry, catalytic and micro-FTIR methods is illustrated using silica- and titania-supported samples. Isothermal CO-O and O2-CO titrations have not been widely used on metal surfaces and may be complicated if some oxide supports are reduced by CO titrant. However, they can illuminate the kinetics of CO oxidation on metal/oxide catalysts since during such titrations all O and CO coverages are scanned as a function of time. There are clear advantages in following the rates of the catalyzed CO oxidation via calorimetry and gc-ms simultaneously. At lower temperatures the evidence they provide is complementary. CO oxidation and its catalysis of CO oxidation have been extensively studied with hysteresis and oscillations apparent, and the present results suggest the benefits of a combined approach. Silica support porosity may be important in defining activity-temperature hysteresis. FTIR microspectroscopy reveals the chemical heterogeneity of the catalytic surfaces used; it is interesting that the evidence with regard to the dominant CO surface species and their reactivities with regard to surface oxygen for present oxide-supported Pt are different from those seen on graphite-supported Pt

Sierra Leone laboratory systems – now and future

No abstract available

Determinants of non-adherence to treatment for tuberculosis in high-income and middle-income settings: a systematic review protocol

INTRODUCTION: Treatment for tuberculosis (TB) is highly effective if taken according to prescribed schedules. However, many people have difficulty adhering to treatment which can lead to poorer clinical outcomes, the development of drug resistance, increased duration of infectivity and consequent onward transmission of infection. A range of approaches are available to support adherence but in order to target these effectively a better understanding of the predictors of poor adherence is needed. This review aims to highlight the personal, sociocultural and structural factors that may lead to poor adherence in high-income and middle-income settings. METHODS AND ANALYSIS: Seven electronic databases, Medline, EMBASE, CINAHL, PsycInfo, The Cochrane Library, Scopus and Web of Science, will be searched for relevant articles using a prespecified search strategy. Observational studies will be targeted to explore factors that influence adherence to treatment in individuals diagnosed with TB. Screening title and abstract followed by full-text screening and critical appraisal will be conducted by two researchers. Data will be extracted using the Population, Exposure, Comparator, Outcomes, Study characteristics framework. For cross-study assessment of strength of evidence for particular risk factors affecting adherence we will use the Grading of Recommendations, Assessment, Development and Evaluation tool modified for prognostic studies. A narrative synthesis of the studies will be compiled. A meta-analysis will be considered if there are sufficient numbers of studies that are homogenous in study design, population and outcomes. DISSEMINATION: A draft conceptual framework will be identified that (A) identifies key barriers to adherence at each contextual level (eg, personal, sociocultural, health systems) and (B) maps the relationships, pathways and mechanisms of effect between these factors and adherence outcomes for people with TB. The draft conceptual framework will guide targeting of adherence interventions and further research. PROSPERO REGISTRATION NUMBER: CRD42017061049

Hypertension Management Through Community Outreach Services for Inmates Released From Jail

Hypertension (HTN) is the most common chronic disease among jail inmates. Many inmates treated for HTN while incarcerated in the Fairfax County Jail do not continue treatment when they return to their communities. Factors that contribute to discontinuing HTN management once the inmate returns to the community include homelessness, low income, and lack of access to care. The purpose of this quality improvement project was to educate inmates with HTN about community-based outreach services for HTN management and continuity of care while in the community. The outcome measured was the number of inmates who returned to jail reporting use of a community-based clinic for follow-up HTN care after their last release from jail. The project was conducted in 2 phases during a 6-month period. A pre-HTN survey questionnaire measuring HTN history and lifestyle was administered on initial incarceration. A post-HTN survey was completed when the inmates return to the jail during the 6-month period and measured adherence to post jail follow up HTN care. The findings of this quality improvement project indicate that both inmates who returned to jail in Phase 2 of the project followed up their HTN care in the community after release from jail. This project shows promise as a first step in the process of social change in planning discharge for inmates with HTN at the time of incarceration

Relations between asylum seekers/refugees’ belonging & identity formations and perceptions of the importance of UK press

This thesis investigates asylum seekers/refugees’ orientations to belonging and identity. It is based on in-depth semi-structured interviews conducted among asylum seekers/refugees residing in Scotland between 2006 and 2008 and on a media monitoring of a number of UK newspapers. The interviews were analysed for interviewees’ orientations to feelings of belonging and identity with the UK, Scotland and homelands. They were also analysed for interviewees’ perceptions (beliefs and understandings) of newspapers’ reporting of asylum and importance to their sense of national belonging and national identity forming. The monitoring provided the context of newspapers’ reporting of asylum at the time of interviews. It enabled a small-scale examination of media content with reference to interviewees’ perceptions. The thesis explores two assumptions. Firstly, asylum seekers/refugees’ national belonging and national identity formations are complex and contingent upon their everyday ‘lived’ experiences. Secondly, asylum seekers/refugees’ belonging and identity formations, as social processes of citizenship, cannot be understood in isolation from the high visibility of the asylum issue in UK media. As an empirical study, therefore, its findings are deployed to critique policymaking, theoretical and media accounts of non-British citizens’ forms of belonging to, and identification with the British ‘nation’. It is suggested that, in addition to policymaking, there are other social circumstances that would facilitate ethnic minority migrants’ national belonging and national identity formations. These factors do not only account for the prioritising of Scottishness over Britishness, but also migrants’ ‘hyphenated’ identities. This thesis will therefore provide evidence suggesting that non-citizens (ethnic minorities), have their own meanings and agency of orientating to a feeling of national belonging and national identity that is nuanced and contingent on their experiences. The thesis does not aim to establish media causality. However, it highlights the fact that newspaper coverage can evoke responses from marginalised groups and provide the context from which identities are narrated and mobilised. The thesis will improve our understanding of the practices, meanings and contestations of belonging and identity that is grounded in the ‘lived’ experiences of noncitizens. This sociological dimension to ethnic minorities’ citizenship forming is not only poorly understood, but has been dominated by theoretical and policymaking accounts in the contemporary state