ResearchPad - open-letter https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Non-biological methods for phosphorus and nitrogen removal from wastewater: A gap analysis of reinvented-toilet technologies with respect to ISO 30500]]> https://www.researchpad.co/article/elastic_article_15636 The aims of the Reinvent the Toilet Challenge (RTTC) include creation of an off-the-grid sanitation system with operating costs of less than US$0.05 per user per day. Because of the small scale at which many reinvented toilets (RT) are intended to operate, non-biological treatment has been generally favored. The RTTC has already instigated notable technological advances in non-sewered sanitation systems (NSSS). However, increasingly stringent liquid effluent standards for N and P could limit the deployment of current RT in real-world scenarios, despite the urgent need for these systems. The newly adopted ISO 30500 standards for water reuse in NSSS dictate minimal use of chemical/biological additives, while at the same time requiring a 70% and 80% reduction in total nitrogen and phosphorus, respectively. This document provides a brief overview of the mature and emerging technologies for N and P (specifically ammonia/ammonium and orthophosphate) removal from wastewater. At present, the dearth of nutrient removal methods proven to be effective at small scales is a significant barrier to meeting ISO 30500 standards. Closing the gap between RTs and ISO 30500 will require significant investments in basic R&D of emerging technologies for non-biological N and P remediation and/or increased reliance on biological processes. Adaptation of existing nutrient-removal technologies to small-scale NSSS is a viable option that merits additional investigation.

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<![CDATA[Standardized approaches for clinical sampling and endpoint ascertainment in tuberculous meningitis studies]]> https://www.researchpad.co/article/elastic_article_10946 Tuberculous meningitis (TBM), the most severe manifestation of tuberculosis, has poorly understood immunopathology and high mortality and morbidity despite antituberculous therapy. This calls for accelerated clinical and basic science research in this field. As TBM disproportionally affects poorer communities, studies are often performed in resource-limited environments, creating challenges for data collection and harmonisation. Comparison of TBM studies has been hampered by variation in sampling strategies, study design and choice of study endpoints. 

Based on literature review and expert consensus, this paper provides firstly, practical recommendations to enable thorough diagnostic, pathophysiological and pharmacokinetic studies using clinical samples, and facilitates better data aggregation and comparisons across populations and settings. Secondly, we discuss clinically relevant study endpoints, including neuroimaging, functional outcome, and cause of death, with suggestions of how these could be applied in different designs for future TBM studies.

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<![CDATA[Standardized approaches for clinical sampling and endpoint ascertainment in tuberculous meningitis studies]]> https://www.researchpad.co/article/N704ac647-bff3-4d6e-b6fa-d68919cdd528

Tuberculous meningitis (TBM), the most severe manifestation of tuberculosis, has poorly understood immunopathology and high mortality and morbidity despite antituberculous therapy. This calls for accelerated clinical and basic science research in this field. As TBM disproportionally affects poorer communities, studies are often performed in resource-limited environments, creating challenges for data collection and harmonisation. Comparison of TBM studies has been hampered by variation in sampling strategies, study design and choice of study endpoints. 

Based on literature review and expert consensus, this paper provides firstly, practical recommendations to enable thorough diagnostic, pathophysiological and pharmacokinetic studies using clinical samples, and facilitates better data aggregation and comparisons across populations and settings. Secondly, we discuss clinically relevant study endpoints, including neuroimaging, functional outcome, and cause of death, with suggestions of how these could be applied in different designs for future TBM studies.

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<![CDATA[African Pharmacogenomics Consortium: Consolidating pharmacogenomics knowledge, capacity development and translation in Africa]]> https://www.researchpad.co/article/N4f453a9a-03ed-4d94-a97d-0e0c140d8b59

The African Pharmacogenomics Consortium (APC) was formally launched on the 6th September 2018. This white paper outlines its vision, and objectives towards addressing challenges of conducting and applying pharmacogenomics in Africa and identifies opportunities for advancement of individualized drugs use on the continent.  Africa, especially south of the Sahara, is beset with a huge burden of infectious diseases with much co-morbidity whose multiplicity and intersection are major challenges in achieving the sustainable development goals (SDG), SDG3, on health and wellness. The profile of drugs commonly used in African populations lead to a different spectrum of adverse drug reactions (ADRs) when compared to other parts of the world. Coupled with the genetic diversity among Africans, the APC is established to promote pharmacogenomics research and its clinical implementation for safe and effective use of medicine in the continent.  Variation in the way patients respond to treatment is mainly due to differences in activity of enzymes and transporters involved in pathways associated with each drug’s disposition.  Knowledge of pharmacogenomics, therefore, helps in identifying genetic variants in these proteins and their functional effects. Africa needs to consolidate its pharmacogenomics expertise and technological platforms to bring pharmacogenomics to use.

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<![CDATA[Integrating environmental health and genomics research in Africa: challenges and opportunities identified during a Human Heredity and Health in Africa (H3Africa) Consortium workshop]]> https://www.researchpad.co/article/N7178d80e-c05a-4bea-a03b-b9ef85d50fdf

Individuals with African ancestry have extensive genomic diversity but have been underrepresented in genomic research. There is also extensive global diversity in the exposome (the totality of human environmental exposures from conception onwards) which should be considered for integrative genomic and environmental health research in Africa. To address current research gaps, we organized a workshop on environmental health research in Africa in conjunction with the H3Africa Consortium and the African Society of Human Genetics meetings in Kigali, Rwanda. The workshop was open to all researchers with an interest in environmental health in Africa and involved presentations from experts within and outside of the Consortium. This workshop highlighted innovative research occurring on the African continent related to environmental health and the interplay between the environment and the human genome. Stories of success, challenges, and collaborative opportunities were discussed through presentations, breakout sessions, poster presentations, and a panel discussion. The workshop informed participants about environmental risk factors that can be incorporated into current or future epidemiology studies and addressed research design considerations, biospecimen collection and storage, biomarkers for measuring chemical exposures, laboratory strategies, and statistical methodologies. Inclusion of environmental exposure measurements with genomic data, including but not limited to H3Africa projects, can offer a strong platform for building gene-environment (G x E) research in Africa. Opportunities to leverage existing resources and add environmental exposure data for ongoing and planned studies were discussed. Future directions include expanding the measurement of both genomic and exposomic risk factors and incorporating sophisticated statistical approaches for analyzing high dimensional G x E data. A better understanding of how environmental and genomic factors interact with nutrition and infection is also needed. Considering that the environment represents many modifiable risk factors, these research findings can inform intervention and prevention efforts towards improving global health.

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<![CDATA[Understanding Ethical, Legal and Societal Issues (ELSIs) in Human Biobanking and Genomics for Research and Healthcare in Zimbabwe: The Genomics Inheritance Law Ethics and Society (GILES) initiative]]> https://www.researchpad.co/article/N20d72830-14f9-40d1-b623-cb49299b71bc

Biobanks and human genomics applications are key for understanding health, disease and heredity in Africa and globally. Growing interest in these technologies calls for strengthening relevant legal, ethical and policy systems to address knowledge disparities and ensure protection of society, while supporting advancement of science. In Zimbabwe there is limited understanding of ethical, legal, and societal issues (ELSI) for biobanking and genomics. The Genomics Inheritance Law Ethics and Society (GILES) initiative was established in 2015 to explore the current status and gaps in the ethical and legal frameworks, knowledge among various stakeholders, and to establish capacity for addressing ELSI of biobanking and genomics as applied in biomedical and population research, and healthcare. The project was conducted over a countrywide geographical region and established one of the most comprehensive studies for ELSI of human biobanking and genomics in Africa. This paper outlines the strategy undertaken during the implementation of the GILES initiative and discusses the importance of such an initiative for characterisation of ELSI of human biobanking and genomics in Zimbabwe and Africa.

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<![CDATA[Potential for diagnosis of infectious disease from the 100,000 Genomes Project Metagenomic Dataset: Recommendations for reporting results]]> https://www.researchpad.co/article/N5daf7df8-ac6b-4f18-bb3c-eb84a14c7a98

The identification of microbiological infection is usually a diagnostic investigation, a complex process that is firstly initiated by clinical suspicion. With the emergence of high-throughput sequencing (HTS) technologies, metagenomic analysis has unveiled the power to identify microbial DNA/RNA from a diverse range of clinical samples (1). Metagenomic analysis of whole human genomes at the clinical/research interface bypasses the steps of clinical scrutiny and targeted testing and has the potential to generate unexpected findings relating to infectious and sometimes transmissible disease. There is no doubt that microbial findings that may have a significant impact on a patient’s treatment and their close contacts should be reported to those with clinical responsibility for the sample-donating patient. There are no clear recommendations on how such findings that are incidental, or outside the original investigation, should be handled. Here we aim to provide an informed protocol for the management of incidental microbial findings as part of the 100,000 Genomes Project which may have broader application in this emerging field. As with any other clinical information, we aim to prioritise the reporting of data that are most likely to be of benefit to the patient and their close contacts. We also set out to minimize risks, costs and potential anxiety associated with the reporting of results that are unlikely to be of clinical significance. Our recommendations aim to support the practice of microbial metagenomics by providing a simplified pathway that can be applied to reporting the identification of potential pathogens from metagenomic datasets. Given that the ambition for UK sequenced human genomes over the next 5 years has been set to reach 5 million and the field of metagenomics is rapidly evolving, the guidance will be regularly reviewed and will likely adapt over time as experience develops.

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<![CDATA[Management of intracranial tuberculous mass lesions: how long should we treat for?]]> https://www.researchpad.co/article/Naa26ca4f-9110-4507-a748-38e82da86fae

Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis ( M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3 rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.

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<![CDATA[Using ‘Theories of Change’ and responsive feedback to design a digital service business for patent and proprietary medicine vendors in Nigeria]]> https://www.researchpad.co/article/N35ba9f1e-b3d4-4808-bdda-0ddbf4bb193d

In a paper titled “Responsive feedback: Towards a new paradigm to enhance intervention effectiveness”, Viswanath et al. argue that dominant models of intervention design do not account for the complexity and unpredictability of implementation challenges.  Particularly in the behavioural sciences, intervention designs need to consider many factors that will be uncertain, or unknown, at the beginning of a new project. 

 This letter describes how we were able to respond to feedback during the design phase of a proof-of-concept project to create a digital service business for Nigerian patent and proprietary medicine vendors (PPMVs).  Our approach was to create an initial ‘Theory of Change’ (ToC) based on a similar project with Kenyan shopkeepers.  This ToC was revised following user feedback and a landscape analysis with key stakeholders.  The new ToC required us to access additional funding to create a ‘digital ordering’ facility for the PPMVs.  Digital ordering provides a mechanism whereby we can reduce the prevalence of counterfeit medicines, offer the PPMVs credit and group-buying facilities, and reduce supply chain costs through co-distribution with fast-moving consumer goods.

 An important learning point was that while our focus was on designing a platform to meet users’ needs, changes in regulation meant that we spent considerably more time than anticipated meeting the needs of multiple stakeholders. However, the importance of ensuring stakeholders’ continued buy-in cannot be underestimated and has likely increased the sustainability of the project in the longer term.

 As Viswanath et al. suggest, for responsive approaches to be widely adopted needs more flexibility than exists in current funding models and project plans.  Both funding bodies and grantees will need to be more responsive to feedback coming from the field.

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<![CDATA[Lessons learned from the Advancing Maternal Immunization collaboration: identifying evidence gaps for informed respiratory syncytial virus maternal immunization decision-making]]> https://www.researchpad.co/article/Nc5e98524-b54f-4c58-b154-184a7a1b6a8b

In an increasingly crowded vaccine landscape, global and country decision-makers will require evidence-based and disease-specific information when prioritizing new public health interventions. The Advancing Maternal Immunization collaboration (AMI) was designed to develop a cross-program strategy to advance respiratory syncytial virus (RSV) maternal immunization (MI) availability and accessibility in low- and middle-income countries by completing a comprehensive RSV MI gap analysis and developing an actionable roadmap report. By engaging and coordinating key stakeholders using a web-based communication platform and developing standardized tools, AMI was able to facilitate interaction and consensus between members. This paper describes the methodology used to create and manage AMI’s work. We share lessons learned from our approach to inform other groups conducting similar work requiring cross-sectoral engagement. This approach could be adapted to efficiently conduct gap analyses for other health interventions that require input and coordination across a variety of topic areas, disciplines, geographies, and stakeholders.

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<![CDATA[Addressing complex societal challenges in health education – A physiotherapy-led initiative embedding inclusion health in an undergraduate curriculum]]> https://www.researchpad.co/article/N78874099-429e-4c3a-9320-756712790280

People who are socially excluded experience vastly poorer health outcomes compared to the general population. Inclusion Health seeks to directly address this health inequity. Despite the increased requirement for health care and the increased prevalence of complex health and social needs in socially excluded people, Inclusion Health features very little in health education curricula.

This letter has been written by a group of clinicians, academics, clinical education specialists and students with a common interest in Inclusion Health. In the absence of established guidance on how best to incorporate the broad topic of inclusion health in undergraduate education, we have developed a two-pronged approach within Physiotherapy. We are writing to highlight the following initiatives; firstly, the provision of a dedicated undergraduate clinical placement devoted to the area of Inclusion Health. Secondly, we have also initiated a step-wise process of introducing the topic of Inclusion Health into the formal undergraduate curriculum.

This letter demonstrates the need to implement strategies to incorporate Inclusion Health into the curriculum and the approaches described are applicable to diverse health professions and settings.

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<![CDATA[An illustration of how responsive feedback in a social marketing tobacco control intervention in Ghana enabled managers to make decisions that increased intervention effectiveness]]> https://www.researchpad.co/article/Na9a5ad02-0feb-43a9-b4e7-763687ae612c

This report illustrates how a feedback loop, set up to provide data and insights to a donor and designers/implementers of a social marketing tobacco prevention intervention in Ghana, helped adapt the original design of the intervention to one that was more suited to the social and media contexts of Ghana. The designers/implementers had previously, successfully implemented a tobacco control intervention with adolescents in Botswana. This experience had informed the initial intervention design in Ghana. As the feedback generated by evaluators started demonstrating just how different the Ghanaian social and media contexts were from the Botswanan one, implementers started making changes to their selection of channels, resulting in a design which was quite different from the original one. The close involvement of the donor in this process enabled implementers to make rapid changes to the design of the intervention. This illustration adds to a small but growing literature establishing the importance of feedback loops to improve the design and implementation of development interventions.

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<![CDATA[Navigating the landscape of non-health administrative data in Scotland: A researcher’s narrative]]> https://www.researchpad.co/article/Nad1cec84-371c-4769-a01f-84ecfc9615b6

Background: There is growing interest in using routinely collected administrative data for research purposes. Following the success of research using routinely collected healthcare data, attention has turned to leveraging routinely-collected non-health data derived from systems providing other services to the population (e.g., education, social security) to conduct research on important social problems. In Scotland, specialised organisations have been set up to support researchers in their pursuit of using and linking administrative data. The landscape of administrative data in Scotland, however, is complex and changeable, and is often difficult for researchers to navigate.

Purpose: This paper provides a researcher’s narrative of the steps required to gain the various approvals necessary to access and link non-health administrative data for research in social and cognitive epidemiology.

Findings: This paper highlights the problems, particularly regarding the length and complexity of the process, which researchers typically face, and which result in a challenging research environment. The causes of these problems are discussed, as are potential solutions.

Conclusions: Whereas the potential of non-health administrative data is great, more work and investment are needed on the part of all those concerned – from researchers to data controllers – in order to realise this potential.

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<![CDATA[Insights from quantitative and mathematical modelling on the proposed WHO 2030 goals for Chagas disease]]> https://www.researchpad.co/article/N882ecc12-8481-4282-9e03-83ad00f6929a

Chagas disease (CD) persists as one of the neglected tropical diseases (NTDs) with a particularly large impact in the Americas. The World Health Organization (WHO) recently proposed goals for CD elimination as a public health problem to be reached by 2030 by means of achieving intradomiciliary transmission interruption (IDTI), blood transfusion and transplant transmission interruption, diagnostic and treatment scaling-up and prevention and control of congenital transmission. The NTD Modelling Consortium has developed mathematical models to study Trypanosoma cruzi transmission dynamics and the potential impact of control measures. Modelling insights have shown that IDTI is feasible in areas with sustained vector control programmes and no presence of native triatomine vector populations. However, IDTI in areas with native vectors it is not feasible in a sustainable manner. Combining vector control with trypanocidal treatment can reduce the timeframes necessary to reach operational thresholds for IDTI (<2% seroprevalence in children aged <5 years), but the most informative age groups for serological monitoring are yet to be identified. Measuring progress towards the 2030 goals will require availability of vector surveillance and seroprevalence data at a fine scale, and a more active surveillance system, as well as a better understanding of the risks of vector re-colonization and disease resurgence after vector control cessation. Also, achieving scaling-up in terms of access to treatment to the expected levels (75%) will require a substantial increase in screening asymptomatic populations, which is anticipated to become very costly as CD prevalence decreases. Further modelling work includes refining and extending mathematical models (including transmission dynamics and statistical frameworks) to predict transmission at a sub-national scale, and developing quantitative tools to inform IDTI certification, post-certification and re-certification protocols. Potential perverse incentives associated with operational thresholds are discussed. These modelling insights aim to inform discussions on the goals and treatment guidelines for CD.

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<![CDATA[Strengthening ethical community engagement in contemporary Malawi]]> https://www.researchpad.co/article/5c19b35bd5eed0c484c534f1

Although community engagement is increasingly promoted in global health research to improve ethical research practice, there is sometimes a disconnect between the broader moral ambitions for community engagement in the literature and guidelines on the one hand and its rather narrower practical application in health research on the other. In practice, less attention is paid to engaging communities for the ‘intrinsic’ value of showing respect and ensuring inclusive participation of community partners in research design. Rather, more attention is paid to the use of community engagement for ‘instrumental’ purposes to improve community understanding of research and ensure successful study implementation. Against this backdrop, we reviewed the literature and engaged various research stakeholders at a workshop to discuss ways of strengthening ethical engagement of communities and to develop context-relevant guidelines for community engagement in health research in Malawi.

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<![CDATA[Call for an enzyme genomics initiative]]> https://www.researchpad.co/article/5b79ad67463d7e0eb3ca3f92

An Enzyme Genomics Initiative is proposed, the goal of which is to obtain at least one protein sequence for each enzyme that has previously been characterized biochemically.

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<![CDATA[Insights from quantitative and mathematical modelling on the proposed 2030 goal for gambiense human African trypanosomiasis (gHAT)]]> https://www.researchpad.co/article/Ne7f20332-b328-4027-871b-f679a17ce890 Gambiense human African trypanosomiasis (gHAT) is a parasitic, vector-borne neglected tropical disease that has historically affected populations across West and Central Africa and can result in death if untreated. Following from the success of recent intervention programmes against gHAT, the World Health Organization (WHO) has defined a 2030 goal of global elimination of transmission (EOT). The key proposed indicator to measure achievement of the goal is zero reported cases. Results of previous mathematical modelling and quantitative analyses are brought together to explore both the implications of the proposed indicator and the feasibility of achieving the WHO goal. Whilst the indicator of zero case reporting is clear and measurable, it is an imperfect proxy for EOT and could arise either before or after EOT is achieved. Lagging reporting of infection and imperfect diagnostic specificity could result in case reporting after EOT, whereas the converse could be true due to underreporting, lack of coverage, and cryptic human and animal reservoirs. At the village-scale, the WHO recommendation of continuing active screening until there are three years of zero cases yields a high probability of local EOT, but extrapolating this result to larger spatial scales is complex. Predictive modelling of gHAT has consistently found that EOT by 2030 is unlikely across key endemic regions if current medical-only strategies are not bolstered by improved coverage, reduced time to detection and/or complementary vector control.  Unfortunately, projected costs for strategies expected to meet EOT are high in the short term and strategies that are cost-effective in reducing burden are unlikely to result in EOT by 2030. Future modelling work should aim to provide predictions while taking into account uncertainties in stochastic dynamics and infection reservoirs, as well as assessment of multiple spatial scales, reactive strategies, and measurable proxies of EOT. ]]>