Independent Research Consultant
Independent Research Consultant
Hoggart L.,Open University Milton Keynes |
Newton V.L.,Queen Mary, University of London |
Bury L.,Independent Research Consultant
Journal of Family Planning and Reproductive Health Care | Year: 2017
Background In recent years there has been growing international interest in identifying risk factors associated with 'repeat abortion', and developing public health initiatives that might reduce the rate. This article draws on a research study looking at young women's abortion experience in England and Wales. The study was commissioned with a specific focus on women who had undergone more than one abortion. We examine what may influence women's post-abortion reproductive behaviour, in addition to exploring abortion-related stigma, in the light of participants' own narratives. Study design Mixed-methods research study: a quantitative survey of 430 women aged 16-24 years, and in-depth qualitative interviews with 36 women who had undergone one or more abortions. This article focuses on the qualitative data from two subsets of young women: those we interviewed twice (n=17) and those who had experienced more than one unintended/unwanted pregnancy (n=15). Results The qualitative research findings demonstrate the complexity of women's contraceptive histories and reproductive lives, and thus the inherent difficulty of establishing causal patterns for more than one abortion, beyond the obvious observation that contraception was not used, or not used effectively. Women who had experienced more than one abortion did, however, express intensified abortion shame. Conclusions This article argues that categorising women who have an abortion in different ways depending on previous episodes is not helpful. It may also be damaging, and generate increased stigma, for women who have more than one abortion. © Published by the BMJ Publishing Group Limited.
Nguyen B.T.,Independent Research Consultant |
Lo Sasso A.T.,University of Illinois at Chicago
Health Economics, Policy and Law | Year: 2017
Our research investigates the effects of the 2005 universal health insurance program for children under age 6 in Vietnam on health care utilization, household out-of-pocket (OOP) spending and self-reported health outcomes using data from the Vietnam Household Living Standard Survey in 2002–2004–2006–2008. We use difference-in-differences to compare children eligible for the program to older children who are ineligible for the program. Results indicate that the program increased insurance coverage by 250% for children age 0–5 relative to the pre-policy period. We found large increases in both outpatient visits and hospital admissions. Health insurance availability also increased outpatient visits at both public and private facilities, suggesting that public and private health care services are complements. Although health insurance was associated with a decrease in inpatient OOP spending for children aged 3–5, it did not reduce outpatient OOP spending for children in general. Health insurance was associated with modest improvements in self-reported health outcomes. Our research suggests that expanded access to insurance among Vietnamese children improved access to care and health outcomes, though it did not necessarily reduce OOP spending. © Cambridge University Press 2017
Jewett E.A.,American Academy of Pediatrics |
Brotherton S.E.,American Medical Association |
Ruch-Ross H.,Independent Research Consultant
Human Resources for Health | Year: 2011
Background: Physicians leaving and reentering clinical practice can have significant medical workforce implications. We surveyed inactive physicians younger than typical retirement age to determine their reasons for clinical inactivity and what barriers, real or perceived, there were to reentry into the medical workforce.Methods: A random sample of 4975 inactive physicians aged under 65 years was drawn from the Physician Masterfile of the American Medical Association in 2008. Physicians were mailed a survey about activity in medicine and perceived barriers to reentry. Chi-square statistics were used for significance tests of the association between categorical variables and t-tests were used to test differences between means.Results: Our adjusted response rate was 36.1%. Respondents were fully retired (37.5%), not currently active in medicine (43.0%) or now active (reentered, 19.4%). Nearly half (49.5%) were in or had practiced primary care. Personal health was the top reason for leaving for fully retired physicians (37.8%) or those not currently active in medicine (37.8%) and the second highest reason for physicians who had reentered (28.8%). For reentered (47.8%) and inactive (51.5%) physicians, the primary reason for returning or considering returning to practice was the availability of part-time work or flexible scheduling. Retired and currently inactive physicians used similar strategies to explore reentry, and 83% of both groups thought it would be difficult; among those who had reentered practice, 35.9% reported it was difficult to reenter. Retraining was uncommon for this group (37.5%).Conclusion: Availability of part-time work and flexible scheduling have a strong influence on decisions to leave or reenter clinical practice. Lack of retraining before reentry raises questions about patient safety and the clinical competence of reentered physicians. © 2011 Jewett et al; licensee BioMed Central Ltd.
Thomas R.E.,University of Calgary |
Lorenzetti D.L.,University of Calgary |
Spragins W.,Independent Research Consultant |
Jackson D.,Independent Research Consultant |
Williamson T.,3280 Hospital Drive NW
Vaccine | Year: 2011
Purpose: To identify the rate of serious adverse events attributable to yellow fever vaccination with 17D and 17DD strains reported in active and passive surveillance data. Methods: We conducted a systematic review of published literature on adverse events associated with yellow fever. We searched 9 electronic databases for peer reviewed and grey literature in all languages. There were no restrictions on date of publication. Reference lists of key studies were also reviewed to identify additional studies. Principal results: We identified 66 relevant studies: 24 used active, 17 a combination of passive and active (15 of which were pharmacovigilance databases), and 25 passive surveillance. Active surveillance: A total of 2,660,929 patients in general populations were followed for adverse events after vaccination, heavily weighted (97.7%) by one large Brazilian study. There were no observed cases of viscerotropic or neurotropic disease, one of anaphylaxis and 26 cases of urticaria (hypersensitivity). We also identified four studies of infants and children (n= 2199), four studies of women (n= 1334), and one study of 174 HIV+, and no serious adverse events were observed. Pharmacovigilance databases: 10 of the 15 databases contributed data to this review, with 107,621,154 patients, heavily weighted (94%) by the Brazilian database. The estimates for Australia were low at 0/210,656 for "severe neurological disease" and 1/210,656 for YEL-AVD, and also low for Brazil with 9 hypersensitivity events, 0.23 anaphylactic shock events, 0.84 neurologic syndrome events and 0.19 viscerotropic events cases/million doses. The five analyses of partly overlapping periods for the US VAERS database provided an estimate of 6.6 YEL-AVD and YEL-AND cases per million, and estimates between 11.1 and 15.6 of overall "serious adverse events" per million. The estimates for the UK were higher at 34 "serious adverse events" and also for Switzerland with 14.6 "neurologic events" and 40 "serious events not neurological" /million doses. Passive surveillance: Six studies of campaigns in general populations included 94,500,528 individuals, very heavily weighted (99%) by the Brazilian data, and providing an estimate of 0.51 serious AEFIs/million doses. Five retrospective reviews of hospital or clinic records included 60,698 individuals, and no serious AEFIs were proven. The data are heavily weighted (96%) by the data from the Hospital for Tropical Diseases, London. Two studies included 35,723 children, four studies included 138 pregnant women, six studies included 191 HIV+ patients, and there was one review of patients who were HIV+, and no serious AEFIs were proven. Major conclusions: The databases in each country used different definitions, protocols, surveillance mechanisms for the initial identification and reporting of cases, and strategies for the clinical and laboratory follow up of cases. The pharmacovigilance databases provide three sets of estimates: a low estimate from the Brazilian and Australian data, a medium estimate from the US VAERS data, and a higher estimate from the UK and Swiss data. The estimates from the active surveillance data are lower (and strongly influenced by the Brazilian data) and the estimates from the passive surveillance studies are also lower (strongly influenced by the London Hospital for Tropical Diseases data from the early 1950s). Sophisticated pathology, histopathology and tests such as PCR amplicon sequencing are needed to prove that serious adverse events were actually caused by the yellow fever vaccine, and the availability of such diagnostic capability is strongly biased towards recent reports from developed countries. Despite these variations in the estimation of serious harm, overall the 17D and 17DD yellow fever vaccine has proven to be a very safe vaccine and is highly effective against an illness with high potential mortality rates. © 2011 Elsevier Ltd.
Mustalahti I.,University of Helsinki |
Bolin A.,Independent Research Consultant |
Boyd E.,University of Reading |
Paavola J.,University of Leeds
Ecology and Society | Year: 2012
The scope of the reducing emissions from deforestation and forest degradation (REDD) mechanism has broadened REDD+ to accommodate different country interests such as natural forests, protected areas, as well as forests under community-based management. In Tanzania the REDD+ mechanism is still under development and pilot projects are at an early stage. In this paper, we seek to understand how local priorities and needs could be met in REDD+ implementation and how these expectations match with global mitigation benefits. We examine the local priorities and needs in the use of land and forest resources in the Angai Villages Land Forest Reserve (AVLFR) in the Liwale District of Lindi Region in Tanzania. Primary data was collected in two villages, Mihumo and Lilombe, using semistructured key informant interviews and participatory rural appraisal methods. In addition, the key informant interviews were conducted with other village, district, and national level actors, as well as international donors. Findings show that in the two communities REDD+ is seen as something new and is generating new expectations among communities. However, the Angai villagers highlight three key priorities that have yet to be integrated into the design of REDD+: water scarcity, rural development, and food security. At the local level improved forest governance and sustainable management of forest resources have been identified as one way to achieve livelihood diversification. Although the national goals of REDD+ include poverty reduction, these goals are not necessarily conducive to the goals of these communities. There exist both structural and cultural limits to the ability of the Angai villages to implement these goals and to improve forestry governance. Given the vulnerability to current and future climate variability and change it will be important to consider how the AVLFR will be managed and for whose benefit?. © 2012 by the author(s). Published here under license by the Resilience Alliance.
Tubeileh A.,California Polytechnic State University, San Luis Obispo |
Rennie T.J.,Independent Research Consultant |
Goss M.J.,University of Guelph
Current Opinion in Plant Biology | Year: 2016
With a dry biomass production exceeding 40 Mg ha-1 in many environments, Miscanthus spp. is the most productive perennial C4 grass species thanks to five advantages over North American prairie tallgrasses. However, miscanthus has a slower nutrient remobilization system, resulting in higher nutrient concentrations at harvest. Perennial C4 grasses benefit from soil microbial associations, reducing their nutrient needs. For combustion purposes, grasses with low moisture content, high lignin and low nutrients are desired. For ethanol, preferred feedstock will have lower lignin, higher sugars, starch, or cellulose/hemicellulose depending on the conversion method. Species with high stem-to-leaf ratio provide better biofuel conversion efficiency and quality. Recently-developed transgenic switchgrass lines have much higher ethanol yields and lower transformation costs. Further selection and breeding are needed to optimize biomass quality and nutrient cycling. © 2016 Elsevier Ltd.
Georgopapadakou N.H.,Independent Research Consultant
Expert Opinion on Investigational Drugs | Year: 2014
Ketolides are erythromycin A derivatives with a keto group replacing the cladinose sugar and an aryl-alkyl group attached to the lactone macrocycle. The aryl-alkyl extension broadens its antibacterial spectrum to include all pathogens responsible for community-acquired pneumonia (CAP): Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis as well as atypical pathogens (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila). Ketolides have extensive tissue distribution, favorable pharmacokinetics (oral, once-a-day) and useful anti-inflammatory/immunomodulatory properties. Hence, they were considered attractive additions to established oral antibacterials (quinolones, β-lactams, second-generation macrolides) for mild-to-moderate CAP. The first ketolide to be approved, Sanofi-Aventis' telithromycin (RU 66647, HMR 3647, Ketek®), had tainted clinical development, controversial FDA approval and subsequent restrictions due to rare, irreversible hepatotoxicity that included deaths. Three additional ketolides progressed to non-inferiority clinical trials vis-à-vis clarithromycin for CAP. Abbott's cethromycin (ABT-773), acquired by Polymedix and subsequently by Advanced Life Sciences, completed Phase III trials, but its New Drug Application was denied by the FDA in 2009. Enanta's modithromycin (EDP-420), originally codeveloped with Shionogi (S-013420) and subsequently by Shionogi alone, is currently in Phase II in Japan. Optimer's solithromycin (OP-1068), acquired by Cempra (CEM-101), is currently in Phase III. Until this hepatotoxicity issue is resolved, ketolides are unlikely to replace established antibacterials for CAP, or lipoglycopeptides and oxazolidinones for gram-positive infections. © 2014 Informa UK, Ltd.
Filippini R.,Independent Research Consultant |
Silva A.,Technical University of Madrid
Reliability Engineering and System Safety | Year: 2014
Critical infrastructures provide services that are essential for the support of everyday activities in modern societies. Being the result of a continuous process of integration of diverse technologies and organizations, they require a multi-disciplinary, systemic approach in order to be understood. In this respect, one of the most challenging issues is the analysis of infrastructures under disturbance or malfunctioning, and their ability to resist, react and recover, in a word the resilience. This paper presents a methodology of resilience analysis of systems of systems, with infrastructures as a special instance. A conceptual representation of the infrastructure, based on the functional relationships among its components, is given and then analyzed with respect to its structural and dynamic properties. Most critical and vulnerable components are identified. The response of the system to failure propagation is simulated in order to check if it is able to cope with them and recover in a resilient fashion. The analysis outcomes are used for a resilience-informed review of the infrastructure. © 2013 Published by Elsevier Ltd. All rights reserved.
Znajda S.K.,Independent Research Consultant
Conservation and Society | Year: 2014
The lack of clear indications of success in integrated conservation and development projects has resulted in strong criticisms of these projects, and a call for the return to conservation activities that exclude local communities. Impeding this discussion is the lack of clarity around how project success is defined and measured in conservation and development projects, especially in terms of development goals. This study involved an in-depth exploration of two agroforestry-focused conservation and development projects in Nicaragua to provide insights into how success in reaching development goals is interpreted in such projects. In both projects, development was equated with increased household income, in contrast to more contemporary definitions that include aspects such as self-respect and social integration. Both projects in turn relied on income as a measure of development success, which ultimately lessened attention to impacts not easily measured quantitatively as well as participant perspectives on desired goals. The paper concludes with a discussion of implications for conservation practitioners; specifically the need for better alignment of project goals with contemporary explanations of development, and a need to move beyond primarily numerical indicators to measure change through an interdisciplinary approach in order to have a more comprehensive understanding of project impacts. © Znajda 2014.
Templeton L.,Independent Research Consultant
Drugs: Education, Prevention and Policy | Year: 2012
Aims: Parental substance misuse is one of the main reasons why grandparents become involved in the care of their grandchildren. This study discusses the key dilemmas faced by a group of such grandparents. Methods: A qualitative study, involving individual interviews and group discussions, with 21 grandparents in one English city. Findings: Three key dilemmas, which the grandparents faced as a result of caring for grandchildren affected by parental substance misuse, are explored, namely dual identities as parents and grandparents, maintaining bonds between grandchildren and their parents and communicating with grandchildren about parental substance misuse. This will be followed by a brief exploration of the support which the grandparents had received in relation to the substance misuse and what they said they would find helpful. Conclusions: Grandparents, regardless of the nature of care they provide to grandchildren, can experience particular challenges when they become involved in their grandchildren's care because of parental substance misuse. An improved framework of response might ensure that the full potential to grandchildren of grandparent care is realized, and for grandparents to be able to provide this care at minimal sacrifice during their later years. Copyright © 2011 Informa UK Ltd.