Severely stigmatised skin neglected tropical diseases: a protocol for social science engagement.

More than one billion people are affected by neglected tropical diseases (NTDs) and many of these diseases are preventable. While the grouping of these conditions as NTDs has generated vast mapping, mass drug administration and surveillance programmes, there is growing evidence of gaps and weaknesses in purely biomedical approaches, and the need for responses that also recognise the social determinants of health. In order to unpack the social and political determinants of NTDs, it is important to view the problem from a social science perspective. Given this background, the Social Sciences for Severe Stigmatizing Skin Diseases (5S) Foundation has recently been established by the Centre for Global Health Research at Brighton and Sussex Medical School. The broad aim of the 5S Foundation is to incorporate social science perspectives in understanding and addressing the problems around three NTDs, namely, podoconiosis, mycetoma and scabies. This protocol paper sets out the aims and approaches of the 5S Foundation while activities such as research, public engagement, training and capacity building get underway.

The TACTIC experience: establishing an international, interdisciplinary network to tackle antimicrobial resistance.

Antimicrobial resistance (AMR) is a major global health threat that requires an interdisciplinary international approach to address. In response to calls from policymakers and funders alike, a growing number of research networks on AMR have been created with this approach in mind. However, there are many challenges facing researchers in establishing such networks and research projects. In this article, we share our experience of establishing the network 'TACTIC: Tackling AMR Challenges through Translational Interdisciplinary Collaborations'. Although presented with many challenges both scientific and logistical, the network has underpinned productive interaction between biomedical and social scientists from several countries and fostered true collaboration in an educative, stimulating and sustainable way that forms a platform for important research on AMR.

Dimensions of the ascending aorta in children and adolescents with repaired Tetralogy of Fallot obtained by cardiac magnetic resonance angiography.

INTRODUCTION: Dilatation of the ascending aorta is a common finding in Tetralogy of fallot (TOF). We sought to provide aortic dimensions in children and adolescents after corrected TOF obtained by contrast-enhanced cardiac-magnetic-resonance angiography (CE-CMRA) that could serve as reference values. MATERIALS AND METHODS: We enrolled 101 children and adolescents (56 male) with a median age of 10.9 years. All patients underwent CE-CMRA imaging using a 3-dimensional spoiled gradient-echo-sequence. Aortic diameters were measured at the level of the aortic valve (AV), aortic sinus (AS), sino-tubular junction (STJ) and the ascending aorta (AA) and compared with normal values obtained from literature. Sex-specific aortic dimensions are given as percentile curves as well as z scores. Furthermore CMR volumetric and functional parameters as well as clinical and anamnestic data were analyzed to identify parameters that are associated with aortic dilatation. RESULTS: Diameters for aortic size for males were 3.6 + 16.6*BSA(0.5) at the AV level, 7.0 + 19.5*BSA(0.5) at the AS level, 7.0 + 14.4*BSA(0.5) at the STJ level and 7.3 + 15.5*BSA(0.5) at the AA level. Diameters for females were 5.8 + 14.1*BSA(0.5) at the AV level, 7.2 + 17.6*BSA(0.5) at the AS level, 5.2 + 15.4*BSA(0.5) at the STJ level and 2.0 + 17.8*BSA(0.5) at the AA level. All diameters in TOF patients were larger compared with normal values. The postoperative interval and age at examination were the only parameters associated with aortic size at all measured levels. CONCLUSION: We provide CE-CMRA data of aortic dimensions in children and adolescents after correction of TOF. Our data might be useful for an estimation of the "normal" aortic size in this patient cohort and can serve as a basis for future longitudinal studies adding prognostic data.

Medical countermeasures for national security: a new government role in the pharmaceuticalization of society.

How do governments contribute to the pharmaceuticalization of society? Whilst the pivotal role of industry is extensively documented, this article shows that governments too are accelerating, intensifying and opening up new trajectories of pharmaceuticalization in society. Governments are becoming more deeply invested in pharmaceuticals because their national security strategies now aspire to defend populations against health-based threats like bioterrorism and pandemics. To counter those threats, governments are acquiring and stockpiling a panoply of 'medical countermeasures' such as antivirals, next-generation vaccines, antibiotics and anti-toxins. More than that, governments are actively incentivizing the development of many new medical countermeasures--principally by marshaling the state's unique powers to introduce exceptional measures in the name of protecting national security. At least five extraordinary policy interventions have been introduced by governments with the aim of stimulating the commercial development of novel medical countermeasures: (1) allocating earmarked public funds, (2) granting comprehensive legal protections to pharmaceutical companies against injury compensation claims, (3) introducing bespoke pathways for regulatory approval, (4) instantiating extraordinary emergency use procedures allowing for the use of unapproved medicines, and (5) designing innovative logistical distribution systems for mass drug administration outside of clinical settings. Those combined efforts, the article argues, are spawning a new, government-led and quite exceptional medical countermeasure regime operating beyond the conventional boundaries of pharmaceutical development and regulation. In the first comprehensive analysis of the pharmaceuticalization dynamics at play in national security policy, this article unearths the detailed array of policy interventions through which governments too are becoming more deeply imbricated in the pharmaceuticalization of society.

Securing circulation pharmaceutically: Antiviral stockpiling and pandemic preparedness in the European Union.

Governments in Europe and around the world amassed vast pharmaceutical stockpiles in anticipation of a potentially catastrophic influenza pandemic. Yet the comparatively 'mild' course of the 2009 H1N1 pandemic provoked considerable public controversy around those stockpiles, leading to questions about their cost-benefit profile and the commercial interests allegedly shaping their creation, as well as around their scientific evidence base. So, how did governments come to view pharmaceutical stockpiling as such an indispensable element of pandemic preparedness planning? What are the underlying security rationalities that rapidly rendered antivirals such a desirable option for government planners? Drawing upon an in-depth reading of Foucault's notion of a 'crisis of circulation', this article argues that the rise of pharmaceutical stockpiling across Europe is integral to a governmental rationality of political rule that continuously seeks to anticipate myriad circulatory threats to the welfare of populations - including to their overall levels of health. Novel antiviral medications such as Tamiflu are such an attractive policy option because they could enable governments to rapidly modulate dangerous levels of (viral) circulation during a pandemic, albeit without disrupting all the other circulatory systems crucial for maintaining population welfare. Antiviral stockpiles, in other words, promise nothing less than a pharmaceutical securing of circulation itself.

Palliative care for long-term care residents: effect on clinical outcomes.

PURPOSE: To determine whether a palliative care (PC) consult service in a long-term care (LTC) facility would result in a more favorable course of treatment and clinical outcomes for participating residents. DESIGN AND METHODS: We used a historical control design within a single LTC facility. Outcome data and potential confounding variables were obtained using the Minimum Data Set. (Health Care Financing Administration. (1995). Long term care resident assessment instrument user's manual version 2.0. Rockville, MD: Health Care Financing Administration.) Residents who died during the period of the PC service (2007-2009) were compared with matched residents who died in the year prior (2006, historical controls). The analysis sample included 250 residents (125 PC residents, 125 non-PC historical control residents). Our main analysis focused on a composite outcome based on utilization patterns, depression, and pain and other clinical indicators. We analyzed change on this component score (and the individual outcomes) over a 1-year period. RESULTS: PC residents experienced a significant reduction in emergency room (ER) visits (p < .001) and depression (p = .031). Change in the composite score indicated a significant difference over time between the 2 groups (p = .013). IMPLICATIONS: Although limited to 1 facility and drawn from a quasi-experimental design, the results demonstrate the potential for improved quality of care with PC consults. The PC team was effective in reducing ER visits and depression and promoted more appropriate care resulting in more favorable clinical outcomes toward the resident's end of life.

Framing global health: the governance challenge.

With the emergence of global health comes governance challenges which are equally global in nature. This article identifies some of the initial limitations in analyses of global health governance (GHG) before discussing the focus of this special supplement: the framing of global health issues and the manner in which this impacts upon GHG. Whilst not denying the importance of material factors (such as resources and institutional competencies), the article identifies how issues can be framed in different ways, thereby creating particular pathways of response which in turn affect the potential for and nature of GHG. It also identifies and discusses the key frames operating in global health: evidence-based medicine, human rights, security, economics and development.

Making new vaccines affordable: a comparison of financing processes used to develop and deploy new meningococcal and pneumococcal conjugate vaccines.

Mechanisms to increase access to health products are varied and controversial. Two innovative mechanisms have been used to accelerate the development of low-price supply lines for conjugate vaccines. The Meningitis Vaccine Project is a so-called push mechanism that facilitated technology transfer to an Indian company to establish capacity to manufacture a vaccine. The Advanced Market Commitment for pneumococcal vaccines is a so-called pull mechanism that guarantees companies a supplement paid in addition to the purchase price for vaccines for a specific period. We compare these approaches, identifying key dimensions of each and considering their potential for replication. We also discuss issues that the Global Alliance for Vaccines and Immunisation (GAVI) face now that these new vaccines are available. Progress towards GAVI's strategic aims is needed and funding is crucial. Approaches that decrease the financial pressure on GAVI and greatly increase political and financial engagement by low-income countries should also be considered.

The clinical nurse specialist role in developing a geropalliative model of care.

PURPOSE: The purpose of this article was to share the experiences and knowledge gained of the clinical nurse specialist's (CNS's) role in the development and implementation of an interdisciplinary geropalliative model of care. BACKGROUND: Across healthcare settings, patients with life-threatening or life-limiting illnesses often experience unwarranted suffering and inattention to their wishes. Studies demonstrate that a palliative approach to care can provide the structure for improved symptom management and earlier identification of patients' goals of care. DESCRIPTION: A palliative model of care was adopted at a 721-bed healthcare facility that encompasses long-term, subacute care, and acute care. The model incorporated a consult team into an embedded approach that provided basic palliative skills in all care. Watson's Caring-Healing Theory guided the model. OUTCOME: Nursing knowledge of palliative care improved, families expressed satisfaction with care, and the staff responded that palliative care positively impacted patient/family outcomes. CONCLUSION: The structure, processes, and outcomes of care can be positively impacted by the CNS during the development and implementation of a palliative model of care. This occurred through CNS activities such as direct consultation, educational initiatives, mentoring, and disseminating assessment and care planning tools. IMPLICATIONS: A geropalliative model of care can be integrated into a variety of healthcare settings. Clinical support and expertise contributed to positive outcomes. Questions for research include the need to identify a symptom assessment tool that is valid, reliable, and easy to use in the chronically ill, geriatric setting, as well as discerning innovative ways to disseminate knowledge to nurses.

Business strategy and access to medicines in developing countries

The availability of generic ARVs was important for the expansion of treatment in developing countries. This paper argues that it is therefore imperative to examine which factors have shaped generics companies' decisions to supply these drugs. This will help us better understand the development of the global AIDS response in the past and how to address some of its future challenges. This paper illustrates the value of combining the investigation of political and economic dynamics with a focus on how they affect the commercial considerations of companies that supply products required by society. In doing so it contributes to the existing literature on business in global governance, which tends to focus on how business affects states' decision-making but neglects how global governance influences companies' decisions to produce some goods and not others.