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الكابتن سالم
أكثر من مجرد قصة مبهجة، يعلمنا الكابتن تومي التفاهم واللطف. يذهب تومي إلى \"معسكر الفضاء\" ويلتقي بجون، الصبي الذي يبدو \"متباعدا\" ومختلفا عن الأطفال الآخرين. مستشار المخيم يجعل تومي قبطان سفينة الفضاء، ويمنحه مهمة جعل جون يتفاعل مع أطفال الفضاء الآخرين. بعد عدة محاولات، نجح تومي، وأظهر جون للجميع كيفية تسلق \"قطب الفضاء\" والانزلاق مرة أخرى إلى الأسفل. يعجب الأطفال، ويصبح جون جزءا حقيقيا من المجموعة، ولم يعد \"ضائعا في الفضاء\".
Book
Establishment of the African Medicines Agency: progress, challenges and regulatory readiness
Insufficient access to quality, safe, efficacious and affordable medical products in Africa has posed a significant challenge to public health for decades. In part, this is attributed to weak or absent policies and regulatory systems, a lack of competent regulatory professionals in National Medicines Regulatory Authorities (NMRAs) and ineffective regional collaborations among NMRAs. In response to national regulatory challenges in Africa, a number of regional harmonisation efforts were introduced through the African Medicines Regulatory Harmonisation (AMRH) initiative to, among others, expedite market authorisation of medical products and to facilitate the alignment of national legislative frameworks with the AU Model Law on Medical Products Regulation. The goals of the model law include to increase collaboration across countries and to facilitate the overall regional harmonisation process. The AMRH initiative is proposed to serve as the foundation for the establishment of the African Medicines Agency (AMA). The AMA will, as one of its mandates, coordinate the regional harmonisation systems that are enabled by AU Model Law domestication and implementation. In this paper, we review the key entities involved in regional and continental harmonisation of medicines regulation, the milestones achieved in establishing the AMA as well as the implementation targets and anticipated challenges related to the AU Model Law domestication and the AMA’s establishment. This review shows that implementation targets for the AU Model Law have not been fully met, and the AMA treaty has not been ratified by the minimum required number of countries for its establishment. In spite of the challenges, the AU Model Law and the AMA hold promise to address gaps and inconsistencies in national regulatory legislation as well as to ensure effective medicines regulation by galvanising technical support, regulatory expertise and resources at a continental level. Furthermore, this review provides recommendations for future research.
Journal Article
The Reintroduction of Beavers to Scotland
Rewilding is a distinctive form of ecological restoration that has emerged quite publicly within environmental policy and conservation advocacy circles. One of the fundamental tenets of rewilding is its emphasis on non-human autonomy, yet empirical examples that examine non-human autonomy are currently limited. While there is a growing body of literature on the biopolitics of broader environmental conservation strategies, there is comparatively little scholarship on the biopolitics of rewilding. This paper argues that autonomy should not be used as a boundary marker to denote ‘wild’ non-humans, but as a situated condition that is variable across locations. It offers an empirical study of the biopolitics that govern the different expressions of non-human autonomy at two different locations in Scotland, where beavers have been reintroduced. The findings reveal how, depending on location and context, modes of governance related to rewilding strategies co-exist and interplay with animal autonomy and forms of power in contradictory ways.
Journal Article
Conducting a Grounded Theory Study in the Wake of a Traumatic Event: A Research Protocol
Aims To explore the perspectives of people who worked at Whakatāne Hospital during and following a mass casualty event from the Whakaari/White Island eruption in New Zealand. Background The eruption of Whakaari / White Island on December 09th, 2019, significantly impacted many people in New Zealand and internationally. Whakatāne Hospital, a rural hospital in New Zealand, received a mass casualty alert in response to this event. Whakaari holds genealogical significance for Māori (Indigenous) people of the Mataatua region, the Eastern Bay of Plenty. Many local stories and waiata (songs) about this ancestral volcano are still told today. Design A research protocol for conducting a grounded theory study in the wake of a traumatic event. Methods Grounded theory (GT), a structured yet flexible methodology, is ideal for understanding a phenomenon in a research area where evidence is limited. It asserts that reality is constructed by those who experience it. In this context, recognising cultural knowledge ( Mātauranga Māori) is crucial to ensure the validity of cultural inclusivity and equity in the research process and generation of data. Conclusion The GT developed from this study will be based on the experiences of selected participants and will also explore the importance of cultural factors, such as indigenous knowledge, in conducting research on traumatic events. Implications for the Profession and for Patient Care The results from this grounded theory research will provide data for healthcare practitioners in developing resources and policies to enhance health system preparedness and responsiveness to disasters, improving future crisis management protocols. Reporting Method EQUATOR guidelines have been adhered to Consolidated criteria for reporting qualitative research COREQ. Public Contribution Mr Arona Smith and Mrs TeReinga.Kingi-Chase were actively involved in the design of this study, contributing their expertise in Mātauranga Māori.
Journal Article
Feral Political Ecologies?
Critical scholars have questioned the shifting dynamics of power and governance involved, how these are enfolded in novel spatial and temporal framings, and the ethical and justice implications for both human-human and human-nonhuman relations. By mobilising scientific knowledge and employing mechanisms such as species lists and the concept of biodiversity, compositionalist conservation has demarcated, ordered and valued nature at both a species-population scale and through the bodies of individuals (Biermann and Mansfield 2014; Braverman 2015). Within this collection, the demarcation of life as protected or ‘made killable’ is a subject of discussion for papers by Clancy and Ward; O'Mahony; Ward and Prior, who evaluate the ways in which the lives of birds, boars and beavers (respectively) are ranked, ordered and regulated according to measures such as breeding and physiology, the extent and locations of territory, and behavioural dynamics. Reintroduction is a central feature of the rewilding movement, to enable the enhancement of trophic complexity and enrich depleted system dynamics (Svenning et al. 2016), but it is a fraught objective.
Journal Article
Auto-rewilding in Post-industrial Cities
The last forty years have seen a dramatic increase in the number of great cormorants (Phalacrocorax carbo) moving inland away from British coastlines. Britain’s largest inland colony currently reside at Walthamstow Wetlands, a nature reserve and functional reservoir system in northeast London, recently branded ‘Europe’s largest urban wetland’. Here, great cormorants are embroiled in contested ideas of nature. Celebrated by conservationists for their resilience and adaptability, yet hounded by anglers for launching ecological chaos on rivers and reservoirs and disrupting the balance that is imagined for urban recreational spaces. This paper argues for a more nuanced version of rewilding that acknowledges the biogeographical complexity and mobility of nonhumans in relation to radically altered ecologies and post-industrial urban environments. It uses the conceptual frame of more-than-human to examine the increased presence, mobility, and agency of great cormorants at Walthamstow Wetlands in terms of nonhuman autonomy and auto-rewilding. The findings demonstrate that the self-relocation and autonomous occupation of inland cormorants in Walthamstow are intimately entangled with human histories and activities, and that they are active alongside humans in creating novel ecosystems.
Journal Article
The domestication of the African Union model law on medical products regulation: Perceived benefits, enabling factors, and challenges
In 2016, the African Union (AU) Model Law on Medical Products Regulation was endorsed by AU Heads of State and Government. The aims of the legislation include harmonisation of regulatory systems, increasing collaboration across countries, and providing a conducive regulatory environment for medical product/health technology development and scale-up. A target was set to have at least 25 African countries domesticating the model law by 2020. However, this target has not yet been met. This research aimed to apply the Consolidated Framework for Implementation Research (CFIR) in analysing the rationale, perceived benefits, enabling factors, and challenges of AU Model Law domestication and implementation by AU Member States.
This study was a qualitative, cross-sectional, census survey of the national medicines regulatory authorities (NRAs) of Anglophone and Francophone AU Member States. The heads of NRAs and a senior competent person were contacted to complete self-administered questionnaires.
The perceived benefits of model law implementation include enabling the establishment of an NRA, improving NRA governance and decision-making autonomy, strengthening the institutional framework, having streamlined activities which attract support from donors, as well as enabling harmonisation, reliance, and mutual recognition mechanisms. The factors enabling domestication and implementation are the presence of political will, leadership, and advocates, facilitators, or champions for the cause. Additionally, participation in regulatory harmonisation initiatives and the desire to have legal provisions at the national level that allow for regional harmonisation and international collaboration are enabling factors. The challenges encountered in the process of domesticating and implementing the model law are the lack of human and financial resources, competing priorities at the national level, overlapping roles of government institutions, and the process of amending/repealing laws being slow and lengthy.
This study has enabled an improved understanding of the AU Model Law process, the perceived benefits of its domestication, and the enabling factors for its adoption from the perspective of African NRAs. NRAs have also highlighted the challenges encountered in the process. Addressing these challenges will result in a harmonised legal environment for medicines regulation in Africa and be an important enabler for the effective operation of the African Medicines Agency.
Journal Article
Towards integrated mental health services in low-income and middle-income countries: organisation of primary healthcare providers – a scoping review protocol
IntroductionMental health conditions constitute a significant percentage of the global burden of disease. A shortfall of mental health specialists and a lack of integration of services in primary care in low-income and middle-income countries (LMICs) contribute towards a mental health treatment gap in excess of 70%. Organising and equipping non-specialist healthcare workers is, therefore, an important strategy for improving access to mental health services in LMICs. This scoping review aims to map literature that addresses the organisation of and support provided to health teams in primary care settings within the context of integrated mental healthcare and as it relates to detection, treatment and referral of mental health conditions. The review will be guided by the ‘Innovative Care for Chronic Conditions’ framework.Methods and analysisThis review protocol will employ the methodological framework first developed by Arksey and O’Malley and later advanced by others and will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews guidelines. This process will entail identifying the research questions, locating relevant literature, choosing eligible reports and studies, extracting the data and summarising the results in English-language studies and reports from 2008 to 2023 will be sourced from PubMed, CINAHL, Cochrane Library, PsycARTICLES, Scopus, Web of Science, Academic Search Complete and the WHO website. A two-stage screening of titles and abstracts, followed by full-text literature will be done in duplicate with blinded authors. Data extraction will be based on predefined fields.Ethics and disseminationAll literature accessed for this scoping review is in the public domain and thus, no approval from an ethics review board is required. The findings of the scoping review report will inform future mental health research in LMIC and will be disseminated to relevant stakeholders and published in a peer-reviewed journal.
Journal Article
High prevalence of undiagnosed obstructive sleep apnoea in the general population and methods for screening for representative controls
Purpose
Undiagnosed obstructive sleep apnoea (OSA) in the community makes comparisons of OSA subjects with control samples from the general population problematic. This study aims to estimate undiagnosed moderate to severe OSA in a general population sample and to determine the capacity of questions from the Berlin questionnaire (BQ) to identify subjects without diagnosed OSA of this severity.
Methods
Using a general population sample (
n
= 793) with no history of OSA, case and control status for moderate–severe OSA was determined by home-based nasal flow and oximetry-derived apnoea–hypopnoea index using a cut-off value of ≥15 events/h to define cases. The diagnostic accuracy of the complete BQ and its component questions in identifying cases was assessed by calculating sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and post-test probabilities.
Results
The age-standardised prevalence estimate of moderate–severe OSA was 9.1 % (12.4 % in men, 5.7 % in women). Sensitivity of the BQ in this population was 54 %, and specificity, 70 %. A combination of questions regarding snoring frequency and hypertension provided maximal post-test probability of OSA and greatest post-screen sample size.
Conclusions
Undiagnosed OSA is highly prevalent in the Western Australian general population. While the complete BQ is a sub-optimal screening instrument for the general population, snoring frequency or hypertension can be used to screen out moderate–severe OSA from general population samples with limited reduction in sample size. As there are few general population samples available for epidemiological or genetic studies of OSA and its associated phenotypes, these results may usefully inform future case–control studies.
Journal Article
Multi-Ethnic, Multisource Grounded Theory: Illustration From a Study Investigating Why Inequities in Survival Occur By Ethnicity
Equity in healthcare is the ideal state where everyone shares equal rights and opportunities. To date, research methodologies are limited in their scope to translate into more equitable healthcare policies and practices. We present a re-interpreted grounded theory methodology to contribute to active dialogue toward optimizing equity through research. This re-interpreted research methodology is presented within a study investigating why ethnic disparities in infant survival from critical congenital heart disease occur in a multi-ethnic national setting in New Zealand. Using dialectical pluralism, we developed an innovative Multi-ethnic, Multisource Grounded Theory methodological concept by deliberately integrating Indigenous and multi-ethnic intersectional perspectives on health inequities from diverse data sources (literature reviews, retrospective case studies, and interview transcripts). Central to the process was the uplifting and centralizing of Indigenous voices. Conceptually, Multi-ethnic, Multisource Grounded Theory could reframe an existing research domain to equip researchers with a framework to intentionally integrate cultural considerations when building information from diverse data in the health equity space. Theoretically, this approach could enhance methodological rigour and support the translation of responsible, ethical, and equitable healthcare models.
Journal Article