"I could not find the strength to resist the pressure of the medical staff, to refuse to give commercial milk formula": a qualitative study on effects of the war on Ukrainian women's infant feeding.

Introduction: During emergencies, breastfeeding protects infants by providing essential nutrients, food security, comfort, and protection and is a priority lifesaving intervention. On February 24, 2022, the war in Ukraine escalated, creating a humanitarian catastrophe. The war has resulted in death, injuries, and mass internal displacement of over 5 million people. A further 8.2 million people have taken refuge in neighboring countries, including Poland. Among those impacted are infants and young children and their mothers. We conducted a study to explore the infant feeding challenges and needs of Ukrainian women affected by the war. Methods: We conducted a qualitative descriptive study involving in-depth interviews (IDIs) with 75 war-affected Ukrainian mothers who had at least one infant aged less than 12 months at the time of the interview. Eligible mothers were either (1) living as Ukrainian refugees in Poland, having crossed the border from Ukraine on or after February 24, 2022, when the war started (n = 30) or (2) living in Ukraine as internally displaced persons or as residents in the community (n = 45). All interviews were audio-recorded (either transcribed or had responses summarized as expanded notes) and analyzed using qualitative thematic analysis using a two-step rapid analysis process. Results: Participants in Ukraine who wanted to initiate breastfeeding right after birth faced opposition from healthcare workers at maternity hospitals. Ukrainian refugees who gave birth in Poland faced language barriers when seeking breastfeeding support. Half of the participants in Ukraine received commercial milk formula (CMF) donations even if they said they did not need them. Most respondents stated that breastfeeding information and support were urgently needed. Conclusion: Our data suggests that healthcare workers in Ukrainian maternity hospitals require additional training and motivation on delivering breastfeeding support. In addition, lactation consultants in maternity ward are needed in Ukraine, and interpretation support is needed for refugees to overcome language barriers. There is a need to control the indiscriminate donations of commercial milk formula and to ensure that complementary foods and commercial milk formula are available to those that need it. This study confirms the need for actions to ensure infant and young child feeding (IYCF) support is provided during emergencies.

Some Interventions to Shift Meta-Norms Are Effective for Changing Behaviors in Low- and Middle-Income Countries: A Rapid Systematic Review.

Social-norms approaches are increasingly included in behavior-change programming. Recent reviews categorize a large number of norms-shifting programs but do not synthesize evidence about effectiveness. To inform the design of social and behavior-change programs in low- and middle-income countries in response to time-sensitive demands, this rapid systematic review examines the evidence for the effectiveness of interventions that use norms-based approaches to change behavior. Nine indexes and eight websites were electronically searched for both systematic reviews and primary studies. Abstracts and full texts were screened to include: documents published in 2010 and later; documents evaluating the effectiveness of programs that include norms-based approaches; documents measuring behavioral outcomes; and documents employing quantitative analysis of concurrent treatment and comparison groups. Data collected include participant age cohort, program name and duration, scope of norms, intervention activities, category of behavioral outcome, and statement of findings for the main behavioral outcome(s). Primary studies were appraised based on identification strategy. Search and screening yielded 7 systematic reviews and 29 primary studies covering 28 programs. Across the primary studies, the programs are highly heterogeneous, and the findings are mixed, with some strong positive effects and many marginal or null effects on behavior change. Taken together, the evidence shows that meta-norms-based approaches can be part of effective programs but do not assure that programs will change behaviors. Program designers can draw some general conclusions from this review but can also use it to locate specific studies relevant to their evidence needs.

The spinosyns, spinosad, spinetoram, and synthetic spinosyn mimics - discovery, exploration, and evolution of a natural product chemistry and the impact of computational tools.

Natural products (NPs) have long been a source of insecticidal crop protection products. Like many macrolide NPs, the spinosyns originated from a soil inhibiting microorganism (Saccharopolyspora spinosa). More than 20 years after initial registration, the spinosyns remain a unique class of NP-based insect control products that presently encompass two insecticidal active ingredients, spinosad, a naturally occurring mixture of spinosyns, and spinetoram, a semi-synthetic spinosyn product. The exploration and exploitation of the spinosyns has, unusually, been tied to an array of computational tools including artificial intelligence (AI)-based quantitative structure activity relationship (QSAR) and most recently computer-aided modeling and design (CAMD). The AI-based QSAR directly lead to the discovery of spinetoram, while the CAMD studies have recently resulted in the discovery and building of a series of synthetic spinosyn mimics. The most recent of these synthetic spinosyn mimics show promise as insecticides targeting lepidopteran insect pests as demonstrated by field studies wherein the efficacy has been shown to be comparable to spinosad and spinetoram. These and a range of other aspects related to the exploration of the spinosyns over the past 30 years are reviewed herein. © 2020 Society of Chemical Industry.

Developing and Monitoring a Standard-of-Care Chimeric Antigen Receptor (CAR) T Cell Clinical Quality and Regulatory Program.

As the world of cellular therapy expands to include immune effector cell (IEC) products such as commercial chimeric antigen receptor (CAR) T cells, quality management (QM) professionals are faced with creating either new IEC stand-alone programs or expand existing hematopoietic cell transplantation (HCT) programs to promote patient safety and be aligned with quality, regulatory, and accreditation requirements. The team professionals at City of Hope (COH) recently expanded the quality HCT program to include IEC products and, in doing so, implemented new regulatory infrastructure while maintaining high quality patient care. At COH, we developed the quality structure of our cellular therapy program through collaborations between quality, regulatory, and CAR T patient care committees, which included physicians and nurse coordinators. To ensure the quality of our program, we monitor data collection and reporting, perform quarterly proactive audits of, for example, outcome analysis, and measure selected end-points for benchmarking purposes. QM professionals play a critical role in the monitoring and evaluation processes and provide guidance on how to implement accreditation requirements and what impact the requirements may have on care management. Here we describe the process by which COH expanded our HCT QM program to include IEC therapy. We share examples of how we developed our overall program structure and other key items such as how we addressed patient care management and accreditation to apprise other programs that wish to create and/or expand existing programs.

Push button replication: Is impact evaluation evidence for international development verifiable?

OBJECTIVE: Empirical research that cannot be reproduced using the original dataset and software code (replication files) creates a credibility challenge, as it means those published findings are not verifiable. This study reports the results of a research audit exercise, known as the push button replication project, that tested a sample of studies that use similar empirical methods but span a variety of academic fields. METHODS: We developed and piloted a detailed protocol for conducting push button replication and determining the level of comparability of these replication findings to original findings. We drew a sample of articles from the ten journals that published the most impact evaluations from low- and middle-income countries from 2010 through 2012. This set includes health, economics, and development journals. We then selected all articles in these journals published in 2014 that meet the same inclusion criteria and implemented the protocol on the sample. RESULTS: Of the 109 articles in our sample, only 27 are push button replicable, meaning the provided code run on the provided dataset produces comparable findings for the key results in the published article. The authors of 59 of the articles refused to provide replication files. Thirty of these 59 articles were published in journals that had replication file requirements in 2014, meaning these articles are non-compliant with their journal requirements. For the remaining 23 of the 109 articles, we confirmed that three had proprietary data, we received incomplete replication files for 15, and we found minor differences in the replication results for five. CONCLUSION: The findings presented here reveal that many economics, development, and public health researchers are a long way from adopting the norm of open research. Journals do not appear to be playing a strong role in ensuring the availability of replication files.

Synthesis and biological potency of anilino-triazine insecticides.

BACKGROUND: An insecticide screening effort identified N-(4-bromophenyl)-4,6-bis(2,2,2-trifluoroethoxy)-1,3,5-triazine-2-amine as having weak potency against two lepidopteran species, Helicoverpa zea and Spodoptera exigua. A structure-activity relationship study about the trifluoroethoxy substituents and the aniline of this compound was carried out in an effort to improve insecticidal potency. RESULTS: Initially, a series of analogs bearing various substituents on the aniline were prepared, and the insecticidal potency was evaluated against H. zea and S. exigua in greenhouse diet feeding assays. The results showed that electron-withdrawing substituents, such as Cl, Br and CF3 , were preferred over electron-donating substituents, such as methoxy, and that potency was significantly better when the substituent was in the para-position. Additional investigations showed that bis(anilino)trifluoroethoxytriazines were more potent. Replacement of the remaining trifluoroethyl group in the bis(anilino)triazine series with an alkyl amine lead to compounds of equal or superior efficacy. CONCLUSION: The work presented showed that electron-withdrawing substituents in the para-position of the aniline ring of the initial hit delivered the best levels of insecticidal potency against the two insect species tested. Further investigations showed that potency could be improved by replacing one of the two trifluoroethoxy groups with additional 4-substituted aniline. This level of potency was maintained or further improved when the remaining trifluoroethoxy was replaced with a substituted amine. © 2017 Society of Chemical Industry.

Quasi-experimental study designs series-paper 4: uses and value.

Quasi-experimental studies are increasingly used to establish causal relationships in epidemiology and health systems research. Quasi-experimental studies offer important opportunities to increase and improve evidence on causal effects: (1) they can generate causal evidence when randomized controlled trials are impossible; (2) they typically generate causal evidence with a high degree of external validity; (3) they avoid the threats to internal validity that arise when participants in nonblinded experiments change their behavior in response to the experimental assignment to either intervention or control arm (such as compensatory rivalry or resentful demoralization); (4) they are often well suited to generate causal evidence on long-term health outcomes of an intervention, as well as nonhealth outcomes such as economic and social consequences; and (5) they can often generate evidence faster and at lower cost than experiments and other intervention studies.

Strength of Evidence on Demand Creation for Voluntary Medical Male Circumcision From 7 Impact Evaluations in Southern and Eastern Africa.

BACKGROUND: Seven new impact evaluations of pilot programs for increasing the demand for voluntary medical male circumcision (VMMC) provide evidence of what works and what does not. The study findings suggest that financial compensation designed to relieve the opportunity or transportation costs from undergoing the procedure can increase the uptake of VMMC. There is also evidence that programs using peer influence can be effective, although so far only sports-based programs demonstrate a strong effect. We explore the strength of evidence in each of these 7 studies to better interpret the findings for policy making. METHODS: We perform a risk of bias assessment and conduct power calculations using actual values for each of the 7 studies. RESULTS: Three of the 7 studies have a medium risk of bias, whereas the other 4 have a low risk of bias. All but 2 of the studies have adequate power to detect meaningful effects. In the 2 with insufficient power, the estimated effects are large but statistically insignificant. CONCLUSION: The positive evidence that financial incentives presented as compensation for opportunity costs to men seeking and obtaining VMMC can increase uptake comes from strong studies, which have high power and low to medium risk of bias. The positive evidence that a comprehensive sports-based program for young men can increase uptake also comes from a strong study. The strength of the studies further validates these findings.

Public readiness for HIV self-testing in Kenya.

High interest and a growing body of evidence suggest that HIV self-testing could help fill the HIV testing gap for populations who have been hesitant to access testing services through current mechanisms. Evidence from five of six studies funded by 3ie answers questions posed by the Kenyan government to understand the readiness of Kenyans for HIV self-testing. The findings suggest that Kenyans are generally ready for HIV self-testing. Most people would not only like to obtain self-test kits through public health facilities but also expect to be able to obtain them from pharmacies - easy access being a key factor for a distribution outlet. Respondents across the studies seem to understand the importance of counseling and confirmatory testing, although the decision to access services after an HIV self-test will certainly be influenced by the results of the test. Respondents do have some concerns about potential harms and abuses from HIV self-tests. These concerns are focused on what they expect others would do, rather than reflections of what they say they would do themselves. Additionally, most people believe that such concerns were mostly unwarranted and/or could be addressed.

Another look at depressive symptoms and antiretroviral therapy adherence: The role of treatment self-efficacy.

Depression has been strongly associated with poor HIV treatment adherence, but little research has explored how individuals manage to follow their regimens despite symptoms of major depression. Using a sample of antiretroviral therapy patients with clinically significant depressive symptoms (n = 84), we examined whether patients with optimal adherence differed from those with suboptimal adherence in terms of the types of depressive symptoms experienced and treatment self-efficacy. There were no significant differences between participants with regard to types of depressive symptoms. Findings indicate that patients with high treatment self-efficacy were more likely to report optimal levels of adherence than patients with low self-efficacy.

A review of the evidence of harm from self-tests.

Although HIV self-testing may overcome some barriers to HIV testing, various stakeholders have expressed concerns that HIV self-testing may lead to unintended harm, including psychological, social and medical harm. Recognizing that similar concerns were raised in the past for some other self-tests, we conduct a review of the literature on a set of self-tests that share some characteristics with HIV self-tests to determine whether there is any evidence of harm. We find that although the potential for harm is discussed in the literature on self-tests, there is very little evidence that such harm occurs.

What's the impact of quality bundles at the bedside?

BACKGROUND: Managing quality bundles can be challenging for clinical nurses. A study was undertaken to examine quality bundle volumes by patient and nursing perceptions in managing those volumes. METHODS: Quantitative and qualitative data were collected from more than 400 patients and their clinical nurses in five hospitals to provide insight into bedside complexities related to quality bundles. QUANTITATIVE FINDINGS: Patients were assigned up to six bundles; critical care patients had the most bundle assignments. QUALITATIVE FINDINGS: Nurses (N = 180) responded to a three-item survey about managing quality bundles. Although 39% of the respondents said they were always aware of the nursing interventions, only 16% responded that they could always complete them. DISCUSSION AND CONCLUSIONS: Strategies to effectively implement quality interventions are critical to nursing workflow and, ultimately, patient care. Workflow assessments, embedded reminders, checklists, and improved data transparency at the bedside are needed to improve quality bundle compliance.

Evaluation of welfare advice in primary care: effect on practice workload and prescribing for mental health.

AIMS: To determine Citizen's Advice Bureaux (CAB) and general practice staff perceptions on the impact of a CAB Health Outreach (CABHO) service on staff workload. To quantify the frequency of mental health issues among patients referred to the CABHO service. To measure any impact of the CABHO service on appointments, referrals and prescribing for mental health. BACKGROUND: GPs and practice managers perceive that welfare rights services, provided by CAB, reduce practice staff workload, but this has not been quantified. METHODS: Interviews with practice managers and GPs hosting and CAB staff providing an advisory service in nine general practices. Comparison of frequency of GP and nurse appointments, mental health referrals and prescriptions for hypnotics/anxiolytics and antidepressants issued before and after referral to the CABHO service, obtained from medical records of referred patients. FINDINGS: Most GPs and CAB staff perceived the service reduced practice staff workload, although practice managers were less certain. CAB staff believed that many patients referred to them had mental health issues. Data were obtained for 148/250 referrals of whom 46% may have had a mental health issue. There were statistically significant reductions in the number of GP appointments and prescriptions for hypnotics/anxiolytics during the six months after referral to CABHO compared with six months before. There were also non-significant reductions in nurse appointments and prescriptions for antidepressants, but no change in appointments or referrals for mental health problems. The quantitative findings therefore confirmed perceptions among both CAB and practice staff of reduced workload and in addition suggest that prescribing may be reduced, although further larger-scale studies are required to confirm this.