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Existing participatory research approaches have failed to identify innovative methods that overcome the persistent barriers to adolescent sexual and reproductive health service demand and access. Increasingly, programmers have turned to human-centered design (HCD), a problem-solving process that centers the needs, perspectives, and experiences of people, when developing solutions to complex SRH challenges. This article describes the application of a youth-engaged version of HCD as part of Adolescents 360, a transdisciplinary initiative to increase 15- to 19-year-old girls’ use of modern contraception in Nigeria, Ethiopia, and Tanzania. Youth-adult design teams (including 111 “youth designers” trained in HCD methods) undertook formative research to inform the design and implementation of interventions. We reflect on the practical implications of using instrumental strategies of HCD with a youth-led participatory approach. Our experience indicates that (1) engaging youth as project partners in transdisciplinary teams requires planned and dedicated financial and human resources; (2) involving youth as action researchers can help identify opportunities to improve program empathy and responsiveness; (3) it is difficult to recruit “extreme users” as project partners because of the high competencies needed in HCD; (4) centering empathy and employing design standards during prototyping can drive decision-making and resolve questions raised by conflicting evidence claims in existing bodies of literature; and (5) testing tangible services and products in real-world settings continues long after the intervention design phase. Youth-adult partnership should continue throughout this iterative and adaptive phase to ensure that the adolescent experience of the intervention remains at the core of intervention delivery.

This paper documents the existence of a ‘formality effect’ in government communications. Across three online studies and three field experiments in different policy contexts (total N  = 67,632), we show that, contrary to researcher and practitioner predictions, formal government communications are more effective at influencing resident behaviour than informal government communications. In exploring mechanisms, we show that formality operates as a heuristic for credibility and importance. Recipients view the source of a formal letter as more competent and trustworthy, and view the request itself as more important to take action on, despite no evidence of change in comprehension or in perceived ease of taking action. These findings have immediate implications for government communicators and open the door for a renewed focus on how the design and presentation of information impacts behaviour. Effective government partly depends on effective communications to citizens. Over six studies in three different policy contexts, Linos et al. identify a counter-intuitive formality effect: citizens are more likely to respond to formal government communications than informal ones.

Human-centred design (HCD) is a problem-solving approach that is increasingly used to develop new global health interventions. However, there is often a large initial cost associated with HCD, and global health decision-makers would benefit from an improved understanding of the cost-effectiveness of HCD, particularly the trade-offs between the up-front costs of design and the long-term costs of delivering health interventions. We developed a quantitative framework from a health systems perspective to illustrate the conditions under which HCD-informed interventions are likely to be cost-effective, taking into consideration five elements: cost of HCD, per-client intervention cost, anticipated number of clients reached, anticipated incremental per-client health benefit (ie, disability-adjusted life years (DALYs) averted) and willingness-to-pay. We evaluated several combinations of fixed and implementation cost scenarios based on the estimated costs of an HCD-informed approach to tuberculosis (TB) contact investigation in Uganda over a 2-year period to illustrate the use of this framework. The cost-effectiveness of HCD-informed TB contact investigation in Uganda was estimated to vary from US$8400 (2400 clients reached, lower HCD cost estimate) to US$306 000 per DALY averted (120 clients reached, baseline HCD cost estimate). In our model, cost-effectiveness was improved further when the interventions were expected to have wider reach or higher per-client health benefits. HCD can be cost-effective when used to inform interventions that are anticipated to reach a large number of clients, or in which the cost of HCD is smaller relative to the cost of delivering the intervention itself.

Clinical decision support (CDS) tools improve clinical diagnostic decision making and patient safety. The availability of CDS to health care professionals has grown in line with the increased prevalence of apps and smart mobile devices. Despite these benefits, patients may have safety concerns about the use of mobile devices around medical equipment. This research explored the engagement of junior doctors (JDs) with CDS and the perceptions of patients about their use. There were three objectives for this research: (1) to measure the actual usage of CDS tools on mobile devices (mCDS) by JDs, (2) to explore the perceptions of JDs about the drivers and barriers to using mCDS, and (3) to explore the perceptions of patients about the use of mCDS. This study used a mixed-methods approach to study the engagement of JDs with CDS accessed through mobile devices. Usage data were collected on the number of interactions by JDs with mCDS. The perceived drivers and barriers for JDs to using CDS were then explored by interviews. Finally, these findings were contrasted with the perception of patients about the use of mCDS by JDs. Nine of the 16 JDs made a total of 142 recorded interactions with the mCDS over a 4-month period. Only 27 of the 114 interactions (24%) that could be categorized as on-shift or off-shift occurred on-shift. Eight individual, institutional, and cultural barriers to engagement emerged from interviews with the user group. In contrast to reported cautions and concerns about the impact of clinicians' use of mobile phone on patient health and safety, patients had positive perceptions about the use of mCDS. Patients reported positive perceptions toward mCDS. The usage of mCDS to support clinical decision making was considered to be positive as part of everyday clinical practice. The degree of engagement was found to be limited due to a number of individual, institutional, and cultural barriers. The majority of mCDS engagement occurred outside of the workplace. Further research is required to verify these findings and assess their implications for future policy and practice.

ObjectivesErrors in prescribing can cause avoidable harm to patients. Establishing the extent of prescribing errors across medical specialties is critical. This research explores the frequency and types of prescribing errors made by healthcare professionals prescribing for patients with renal disease where prescribing problem-solving and decision-making is complex due to comorbidity.MethodsAll prescriptions and errors made by prescribers were captured over a 4-month period in a UK renal unit. Data were recorded concerning the medicine associated with the error, the type and severity of the error, and the prescriber's occupational grade.Results10 394 prescribed items were captured and 3.54% had associated prescribing errors. While Foundation Year 1 doctors made almost one error each week (mean 15.13) and Foundation Year 2 doctors one every 2 weeks (mean 8.00), other prescribers made one error per month (mean 3.94). The medicines most frequently associated with errors for Foundation doctors were paracetamol (6.51%), calcium acetate (5.33%), meropenem (3.55%), alfacalcidol (3.55%) and tazocin (3.55%), while for all other prescribers they were meropenem (6.15%), alfacalcidol (4.62%), co-amoxiclav (4.62%) and tacrolimus (4.62%). The most common types of error for both groups were omitting the indication, using the brand name inappropriately, and prescribing inaccurate doses.ConclusionsThe range of errors made by multi-professional healthcare prescribers confirms the complexity of prescribing on a renal unit for patients with kidney disease and multimorbidity. These findings have implications for the types of educational interventions required for reducing avoidable harm and overcoming human factors challenges to improve prescribing behaviour.

[...]these three Grand Duos are dedicated to Monsieur Frederic Weller (which should have come out as Frédéric if the publisher had his wits and his diacriticals about him). Weller made arrangements for wind band (one notably of Weber's Oberon) and one of his wind band compositions, Ein musikalische Spass (A Musical Joke), calls for instruments to mimic birdsong (piccolo/nightingale; trumpets/cockerels; basset-horn and even bass trombone as cuckoos!). Johann Walch (1776-1855), a prolific composer of wind band music, mainly organised into 29 Books of Pièces d'Harmonie, dedicated Book 22 to Weller. The contrapuntal skill and melodic invention is high and they are of a style similar to the Wilhelm Kopprasch duets or the Bedrich Dionys Weber quartets - that is, 1830ish, playable by skilled hand horn players but, especially in the slow movements, with passages employing pedal notes, and the a, f, and e below middle c', that would be uncomfortable and better with valves.

Fast-paced, emotionally wrought, entertaining political drama that brings to life the tumultuous days immediately following the UK general election in 2010. As the polls close and the votes are counted, a different picture emerges for each of the three main political parties. The Liberal Democrats, often a distant third in previous elections, hold the balance of power. With no clear winner, this could finally be their chance to govern. But will it be alongside Labour or the Conservatives? Liberal leader Nick Clegg finds himself with the power to change the landscape of British politics - and the fate of his party - with one critical decision. Diving straight into the heart of this fraught and frenzied situation, Coalition reveals the individual decisions, personal sacrifices and divisive compromises made at a pivotal time in British politics and exposes a clandestine game of government-building hidden within the corridors of power.