School uniform and other costs of schooling: views and experiences in Wales (technical report & final report)

"The overall aim of the research was... to explore the views of parents/carers and young people in Wales on the validity, usefulness and benefits of having school uniforms and their experiences and views on the cost and availability of buying uniforms, and to explore how the wider costs of schooling impacts on children, families and schools." - research aims & objectives

Dispositional Essentialism and Ontic Structural Realism - a hybrid view

Dispositional Essentialism and Ontic Structural Realism aim to account for modality. Dispositional Essentialism takes properties to account for laws. In particular, it takes determinate properties to account for laws of nature (Bird, 2007), which are determinable. Ontic Structural Realism does the reverse. According to Steven French, Ontic Structural Realism takes laws and symmetries to be part of the fundamental structure of the world. Determinate properties are “dependent” on laws (2014, p. 264). The core difference between Dispositional Essentialism and Ontic Structural Realism’s accounts of modality is the direction of the dependence between properties and laws. As a result, French describes Ontic Structural Realism as a reverse-engineering of Dispositional Essentialism (2014, p. 264), and Chakravartty differentiates them by saying that Dispositional Essentialism gives a bottom-up account of modality whereas Ontic Structural Realism’s is top-down (2019). Both views face significant problems. The main problems these views face stem from relational individuation. Properties are individuated by their relations to further properties. As such, it is hard to see how they can be metaphysically prior to those relations as per Dispositional Essentialism. Equally, laws are relations between properties. As such, it is hard to see how they could be metaphysically prior to the properties they relate as per Ontic Structural Realism. Both properties and laws seem dependent on each other. By requiring one to come first and explain the other, dispositional essentialists and ontic structural realists end up in a chicken-egg scenario. I propose a hybrid between Dispositional Essentialism and Ontic Structural Realism. My hybrid view does away with the dogma of ontological priority between properties and laws. Instead, properties and laws symmetrically depend. I argue that my hybrid view is the way out of the chicken-egg-property-law conundrum. It paves a new way for making sense of modality from a structuralist perspective

Shining a Light on Task-Shifting Policy : Exploring opportunities for adaptability in non-communicable disease management programmes in Uganda

In terms of disease burden, many low- and middle-income countries are currently experiencing a transition from infectious to chronic diseases. In Uganda, non-communicable diseases (NCDs) have increased significantly in recent years; this challenge is compounded by the healthcare worker shortage and the underfunded health system administration. Addressing the growing prevalence of NCDs requires evidence-based policies and strategies to reduce morbidity and mortality rates; however, the integration and evaluation of new policies and processes pose many challenges. Task-shifting is the process whereby specific tasks are transferred to health workers with less training and fewer qualifications. Successful implementation of a task-shifting policy requires appropriate skill training, clearly defined roles, adequate evaluation, an enhanced training capacity and sufficient health worker incentives. This article focuses on task-shifting policy as a potentially effective strategy to address the growing burden of NCDs on the Ugandan healthcare system

Validation of the Sustainable Development Goal 6 Monitoring Structures across East and Southern Africa Using Fuzzy Logic Analysis

The United Nations Children’s Fund (UNICEF) and World Health Organisation (WHO) Joint Monitoring Programme (JMP) reports that only three African countries are on track to achieve universal access to at least basic water services by 2030 and only one country, Botswana, within the East and Southern Africa region (ESAR). Monitoring is crucial to advancing progress on SGD 6 in the region through providing reliable data to decision makers for policy, planning and much needed investment in the sector. This paper presents findings of the rapid assessment termed SDG 6 + 5 which relates to monitoring systems for Water Supply, Sanitation and Hygiene (WASH) in 21 countries of ESAR, five years into the SDGs. The paper presents the results of a fuzzy logic analysis applied to aspects and findings from the rapid assessment. Fuzzy logic benefits the study by managing unconscious bias from qualitative assessment and evaluating the strengths of countries’ WASH monitoring systems. The paper demonstrates similarities and variations between results from the rapid assessment and fuzzy analysis including Angola and Botswana scoring more favourably in enabling environments for monitoring from the analysis. The paper provides methods of rapid assessment of key aspects that impact on effective WASH monitoring and recommends the use of fuzzy logic to reduce data bias from qualitative methods. The methodology presented in the paper can be adapted and applied to other regions of the world and settings to enhance evaluations on the strength of systems within other sectors

Validation of the UNICEF fiscal diagnostic tool for SDGs 6.1 and 6.2 in East and Southern Africa using the analytical hierarchy process (AHP)

The UN High Level Panel on Water notes that a total annual capital expenditure (CAPEX) of $114 billion and operation and maintenance expenditure (OPEX) of$129 billion is required globally to meet the safe drinking water and sanitation targets 1 and 2 of Sustainable Development Goal 6 (SDG 6). In Sub-Saharan Africa, $36 billion is required and UNICEF estimates$15 billion is required to meet these targets in 21 countries in East and Southern Africa. Currently, only 15% of the financial investments in the sector are accounted for, which falls significantly short of delivering SDG 6. Consequently, innovative finance tools that maximise taxes, tariffs and transfers (3ts) are required to mobilise finances for the region's sector. This paper presents a diagnostic methodology for identifying bankable and blended finance projects in East and Southern Africa's water and sanitation sector. Potential projects were identified in Malawi, Mozambique and Ethiopia. Findings from applying the AHP (analytical hierarchy process) analysis recommend the use of the decision-making tool for prioritisation and selection of water and sanitation projects in the context of multiple projects requiring blended finance. The methods are applicable to other parts of Sub-Saharan Africa to enhance project pipelines whose collective cost and revenue mitigate investment risk

Exploring professional circus artists’ experience of performance-related injury and management

AIMS: Circus is a physically demanding profession, but injury and help-seeking rates tend to be low. This qualitative interview study explored the perceptions and beliefs about injury and help-seeking of circus artists. METHODS: Ten professional circus artists (5 males, 5 females; mean age 33 yrs, range 27-42) were enrolled. Individual, semi-structured interviews were conducted until data saturation of themes was reached. Data were analysed thematically. FINDINGS: Four themes were identified: 1) the injured artist; 2) professionalism; 3) circus life; and 4) artists' experience of healthcare. Most participants described the circus as central to their lives, and injuries had wide-ranging psychosocial consequences. Injury adversely affected participants' mood and threatened their identity. Situational and personal factors (e.g., the belief that pain was normal) pushed participants to use adaptive strategies to perform when injured. Continuous touring and financial constraints affected help-seeking. Easy access to healthcare was rare and participants often self-managed injuries. Experiences of healthcare varied, and participants desired flexible and accessible approaches to prevention and injury management. A modified version of the integrated model of psychological response to injury and rehabilitation process and the concept of identity provided a framework to understand participants. CONCLUSION: Injuries had extensive negative consequences. Work schedules, financial factors, employer support, the artist's perception of the importance of the show, and the relationship between circus and identity influenced injury management and help-seeking. Injury prevention and management strategies could be optimised by developing centres of expertise, online resources, and better regulations of the profession

The work of older people and their informal caregivers in managing an acute health event in a hospital at home or hospital inpatient setting.

BACKGROUND: There is limited understanding of the contribution made by older people and their caregivers to acute healthcare in the home and how this compares to hospital inpatient healthcare. OBJECTIVES: To explore the work of older people and caregivers at the time of an acute health event, the interface with professionals in a hospital and hospital at home (HAH) and how their experiences relate to the principles underpinning comprehensive geriatric assessment (CGA). DESIGN: A qualitative interview study within a UK multi-site participant randomised trial of geriatrician-led admission avoidance HAH, compared with hospital inpatient care. METHODS: We conducted semi-structured interviews with 34 older people (15 had received HAH and 19 hospital care) alone or alongside caregivers (29 caregivers; 12 HAH, 17 hospital care), in three sites that recruited participants to a randomised trial, during 2017-2018. We used normalisation process theory to guide our analysis and interpretation of the data. RESULTS: Patients and caregivers described efforts to understand changes in health, interpret assessments and mitigate a lack of involvement in decisions. Practical work included managing risks, mobilising resources to meet health-related needs, and integrating the acute episode into longer-term strategies. Personal, relational and environmental factors facilitated or challenged adaptive capacity and ability to manage. CONCLUSIONS: Patients and caregivers contributed to acute healthcare in both locations, often in parallel to healthcare providers. Our findings highlight an opportunity for CGA-guided services at the interface of acute and chronic condition management to facilitate personal, social and service strategies extending beyond an acute episode of healthcare

Integrating tuberculosis and HIV services for people living with HIV: costs of the Zambian ProTEST Initiative.

BACKGROUND: In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH) in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT) acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC), and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy. METHODS: Annual financial and economic providers costs and output measures were collected in 2000-2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight. RESULTS: Annual core ProTEST costs were (in 2007 US dollars) $84,213 in Chawama and$31,053 in Matero. The cost of coordination was 4%-5% of total site costs ($1-$6 per person reached). The largest cost component in Chawama was voluntary counselling and testing (56%) and the clinic in Matero (50%), where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was$24. CONCLUSION: This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV

The long-term effects of a family based economic empowerment intervention (Suubi+Adherence) on suppression of HIV viral loads among adolescents living with HIV in southern Uganda: Findings from 5-year cluster randomized trial

BACKGROUND: The rapid scale-up of HIV therapy across Africa has failed to adequately engage adolescents living with HIV (ALWHIV). Retention and viral suppression for this group (ALWHIV) is 50% lower than for adults. Indeed, on the African continent, HIV remains the single leading cause of mortality among adolescents. Strategies tailored to the unqiue developmental and social vulnerabilities of this group are urgently needed to enhance successful treatment. METHODS: We carried out a five-year longitudinal cluster randomized trial (ClinicalTrials.gov ID: NCT01790373) with adolescents living with HIV (ALWHIV) ages 10 to 16 years clustered at health care clinics to test the effect of a family economic empowerment (EE) intervention on viral suppression in five districuts in Uganda. In total, 39 accredited health care clinics from study districts with existing procedures tailored to adolescent adherence were eligible to participate in the trial. We used data from 288 youth with detectable HIV viral loads (VL) at baseline (158 -intervention group from 20 clinics, 130 -non-intervention group from 19 clinics). The primary end point was undetectable plasma HIV RNA levels, defined as \u3c 40 copies/ml. We used Kaplan-Meier (KM) analysis and Cox proportional hazard models to estimate intervention effects. FINDINGS: The Kaplan-Meier (KM) analysis indicated that an incidence of undetectable VL (0.254) was significantly higher in the intervention condition compared to 0.173 (in non-intervention arm) translated into incidence rate ratio of 1.468 (CI: 1.064-2.038), p = 0.008. Cox regression results showed that along with the family-based EE intervention (adj. HR = 1.446, CI: 1.073-1.949, p = 0.015), higher number of medications per day had significant positive effects on the viral suppression (adj.HR = 1.852, CI: 1.275-2.690, p = 0.001). INTERPRETATION: A family economic empowerment intervention improved treatment success for ALWHIV in Uganda. Analyses of cost effectiveness and scalability are needed to advance incorporation of this intervention into routine practice in low and middle-income countries