Using Innovation to Develop Digital Tools for Public Health During the COVID-19 Pandemic

Introduction: Technology has played a key role in enabling public health to respond to the COVID-19 pandemic at a pace and scale never seen before. The Digital Health and Care Innovation Centre (DHI) assisted with development of two new digital services to enable testing and contact tracing at scale using innovative methods. Methods: The DHI employed a design innovation approach by bringing all relevant stakeholders together to co-design new technology services to identify the ‘preferred future’. Workshops were used to identify the preferred solutions. The innovative methods for development of digital health tools included adopting an iterative approach, addressing the situational requirements posed by COVID-19, and democratising technology for purposes of pandemic control. Results: A National Notification Service (NNS) for automation of delivery and feedback (if results messages were viewed) was developed and adopted by five of the 14 health boards in Scotland, processing over 7 million results since inception. The Simple Tracing Tools (STT) is an open-platform web-based app that is designed for data entry by contact tracing teams. STT was adopted by all local health protection teams and informed development of the national case management system. Discussion: The Cynefin framework can be used to understand the design innovation process when facing the challenges of designing digital tools during a pandemic. There are significant opportunities for public health to engage with digital health to transform the pandemic response and derive benefit for tackling future population health challenges

A multicenter comparison between Child Pugh and ALBI scores in patients treated with sorafenib for hepatocellular carcinoma

Background & aims: The ALBI grade was proposed as an objective means to evaluate liver function in patients with Hepatocellular Carcinoma (HCC). ALBI grade 1 vs 2 were proposed as stratification factors within the Child Pugh (CP) A class. However, the original publication did not provide comparison with the sub-classification by points (5 to 15) within the CP classification. Methods: We retrospectively analyzed data from patients treated with sorafenib for HCC from 17 centers in United Kingdom and France. Overall survival (OS) was analyzed with the Kaplan-Meier method and a Cox regression model. Discriminatory abilities of the classifications were assessed with the log likelihood ratio, Harrell’s C statistics and Akaike information criterion. Results: Data from 1,019 patients were collected, of which 905 could be assessed for both scores. 92% of ALBI grade 1 were CP A5 while ALBI 2 included a broad range of CP scores of which 44% were CP A6. Median OS was 10.2, 7.0 and 3.6 months for CP scores A5, A6 and >A6, respectively (P<0.001), Hazard Ratio (HR)=1.60 (95%CI: 1.35-1.89, P<0.001) for A6 vs A5. Median OS was 10.9, 6.6 and 3.0 months for ALBI grade 1, 2 and 3, respectively (P<0.001), HR=1.68 (1.43-1.97, P<0.001) for grade 2 vs 1. Discriminatory abilities of CP and ALBI were similar in the CP A population, but better for CP in the overall population. Conclusions: Our findings support the use CP class A as an inclusion criterion, and ALBI as a stratification factor in trials of systemic therapy

Commission on Russian-American Relations 2010

Created as part of the 2010 Jackson School for International Studies SIS 495: Task Force. Robert Huber, Task Force Advisor; Martin Sletzinger, Evaluator

Menstrual hygiene management and sustainable development

Menstrual hygiene management (MHM) is the process of managing menstrual blood, produced during menstruation by females from adolescence until perimenopause. The UNICEF and UNICEF definition highlights the need for “clean menstrual management material to absorb or collect menstrual blood,” and the need for these to be “changed in privacy as often as necessary” during a menstrual period as well as privacy and access to “soap and water for washing the body as required,” and “access to facilities to dispose of used menstrual management materials” (WHO/UNICEF 2012). Effective healthy menstrual hygiene management in this definition involves access – to information, materials, facilities, soap, and water and to dispose of materials but this is by no means the whole story. A number of sociocultural issues and taboos surround the subject of menstruation, making this a challenging topic, locally and globally

Diverse intracellular pathogens activate Type III Interferon expression from peroxisomes

Type I Interferon (IFN) responses are considered the primary means by which viral infections are controlled in mammals. Despite this view, several pathogens activate antiviral responses in the absence of Type I IFNs. The mechanisms controlling Type I IFN-independent responses are undefined. We have found that RIG-I like Receptors (RLRs) induce Type III IFN expression in a variety of human cell types, and identified factors that differentially regulate Type I and III IFN expression. We identified peroxisomes as a primary site that initiates Type III IFN expression, and revealed that the process of intestinal epithelial cell differentiation upregulates peroxisome biogenesis and promotes robust Type III IFN responses in human cells. These findings highlight the interconnections between innate immunity and cell biology

Patterns of Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Secondary Analysis of the ESPAC-4 Randomized Adjuvant Chemotherapy Trial

Importance: The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma with adjuvant chemotherapy remain unclear. Objective: To define patterns of recurrence after adjuvant chemotherapy and the association with survival. Design, Setting, and Participants: Prospectively collected data from the phase 3 European Study Group for Pancreatic Cancer 4 adjuvant clinical trial, an international multicenter study. The study included 730 patients who had resection and adjuvant chemotherapy for pancreatic cancer. Data were analyzed between July 2017 and May 2019. Interventions: Randomization to adjuvant gemcitabine or gemcitabine plus capecitabine. Main Outcomes and Measures: Overall survival, recurrence, and sites of recurrence. Results: Of the 730 patients, median age was 65 years (range 37-81 years), 414 were men (57%), and 316 were women (43%). The median follow-up time from randomization was 43.2 months (95% CI, 39.7-45.5 months), with overall survival from time of surgery of 27.9 months (95% CI, 24.8-29.9 months) with gemcitabine and 30.2 months (95% CI, 25.8-33.5 months) with the combination (HR, 0.81; 95% CI, 0.68-0.98; P = .03). The 5-year survival estimates were 17.1% (95% CI, 11.6%-23.5%) and 28.0% (22.0%-34.3%), respectively. Recurrence occurred in 479 patients (65.6%); another 78 patients (10.7%) died without recurrence. Local recurrence occurred at a median of 11.63 months (95% CI, 10.05-12.19 months), significantly different from those with distant recurrence with a median of 9.49 months (95% CI, 8.44-10.71 months) (HR, 1.21; 95% CI, 1.01-1.45; P = .04). Following recurrence, the median survival was 9.36 months (95% CI, 8.08-10.48 months) for local recurrence and 8.94 months (95% CI, 7.82-11.17 months) with distant recurrence (HR, 0.89; 95% CI, 0.73-1.09; P = .27). The median overall survival of patients with distant-only recurrence (23.03 months; 95% CI, 19.55-25.85 months) or local with distant recurrence (23.82 months; 95% CI, 17.48-28.32 months) was not significantly different from those with only local recurrence (24.83 months; 95% CI, 22.96-27.63 months) (P = .85 and P = .35, respectively). Gemcitabine plus capecitabine had a 21% reduction of death following recurrence compared with monotherapy (HR, 0.79; 95% CI, 0.64-0.98; P = .03). Conclusions and Relevance: There were no significant differences between the time to recurrence and subsequent and overall survival between local and distant recurrence. Pancreatic cancer behaves as a systemic disease requiring effective systemic therapy after resection. Trial Registration: Clinicaltrials.gov Identifier: NCT00058201, EudraCT 2007-004299-38, and ISRCTN 96397434