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Background Successful mass vaccination programmes are public health achievements of the contemporary world. While pharmaceutical companies are actively developing new vaccines, and demonstrating results of effectiveness and safety profiles, concerns on COVID-19 vaccine management are under-reported. We aimed to synthesise the evidence for efficient cold chain management of COVID vaccines. Methods The scoping review’s conduct and reporting were based on the PRISMA–ScR 2018 checklist. We searched from April 2020 to January 2022 for publications in PubMed (LitCovid), Scopus and ScienceDirect. All review stages were pilot-tested to calibrate 2 reviewers. Articles on cold chain logistics and management were included, while publications solely describing COVID vaccines, their development and clinical aspects of the vaccine, were excluded. To capture relevant data, charting was conducted by one reviewer and verified by another. Results were analysed thematically and summarised descriptively in a table and in-text. Results and discussion We assessed 6984 potentially relevant citations. We included 14 publications originating from USA ( n  = 6), India ( n  = 2), Finland, Spain, Bangladesh, Netherlands, Switzerland and Ethiopia. They were reported as reviews (4), policy or guidance documents (3), experimental studies (2), case reports (2), expert commentary (1), phenomenological study (1), and decision-making trial and evaluation laboratory trial (1). The findings were presented in three themes: (i) regulatory requirements for cold-chain logistics, (ii) packaging and storage, and (iii) transportation and distribution. A conceptual framework emerged linking regulatory requirements, optimal logistics operation and formulation stability as the key to efficient cold chain management. Recommendations were made for improving formulation stability, end-product storage conditions, and incorporating monitoring technologies. Conclusion COVID-19 vaccines require special end-to-end supply cold chain requirements, from manufacture, and transportation to warehouses and healthcare facilities. To sustain production, minimise wastage, and for vaccines to reach target populations, an efficient and resilient vaccine supply chain which is assisted by temperature monitoring technologies is imperative.

The objectives of conservation science and dissemination of its research create a paradox: Conservation is about preserving the environment, yet scientists spread this message at conferences with heavy carbon footprints. Ecology and conservation science depend on global knowledge exchange—getting the best science to the places it is most needed. However, conference attendance from developed countries typically outweighs that from developing countries that are biodiversity and conservation hotspots. If any branch of science should be trying to maximize participation while minimizing carbon emissions, it is conservation. Virtual conferencing is common in other disciplines, such as education and humanities, but it is surprisingly underused in ecology and conservation. Adopting virtual conferencing entails a number of challenges, including logistics and unified acceptance, which we argue can be overcome through planning and technology. We examined 4 conference models: a pure-virtual model and 3 hybrid hub-and-node models, where hubs stream content to local nodes. These models collectively aim to mitigate the logistical and administrative challenges of global knowledge transfer. Embracing virtual conferencing addresses 2 essential prerequisites of modern conferences: lowering carbon emissions and increasing accessibility for remote, time- and resource-poor researchers, particularly those from developing countries. Los objetivos de la ciencia de la conservación y la difusión de su investigación genera una paradoja: la conservación se enfoca en preservar el ambiente, pero los científicos dispersan este mensaje en conferencias con huellas de carbono pesadas. La ecología y la ciencia de la conservación dependen del intercambio de conocimiento global - hacer llegar a la mejor ciencia a los lugares en donde es más necesitada. Sin embargo, la asistencia de países desarrollados a conferencias típicamente sobrepasa a aquella de países en desarrollo que son puntos calientes de biodiversidad y conservación. Si hay una rama de la ciencia que debería estar intentando maximizar la participación mientras minimiza las emisiones de carbono, es la conservación. Las conferencias virtuales son comunes en otras disciplinas, como la educación y las humanidades, pero está sorprendentemente subutilizada en la ecología y en la conservación. Adoptar las conferencias virtuales conlleva un número de retos, incluyendo la logística y la aceptación unánime, que discutimos pueden sobreponerse por medio de la planificación y la tecnología. Examinamos cuatro modelos de conferencias: un modelo puramente virtual y tres modelos híbridos de núcleo-y-nodo, en los que los núcleos transmiten el contenido a los nodos locales. Estos modelos buscan colectivamente mitigar los retos logísticos y administrativos de la transferencia global de conocimientos. La adopción de las conferencias virtuales resuelve dos prerrequisitos esenciales de las conferencias modernas: reducir las emisiones de carbono e incrementar la accesibilidad para los investigadores remotos y escasos de tiempo y recursos, particularmente aquellos en los países en desarrollo.

Improving spatial access to healthcare facilities is of great interest in urban planning. However, most facility location models fall short of explicitly incorporating the spatial accessibility measure in designing facility locations. Thus, this paper develops a novel framework to directly improve spatial access to healthcare facilities, by integrating spatial analysis with an optimization model. Specifically, by leveraging multiple types of data, this framework could: (1) estimate healthcare demands using machine learning models from large-scale mobile phone data; (2) calibrate the travel time decay effect based on human mobility patterns and road networks; (3) calculate spatial accessibility scores; and (4) optimize the location of hospitals with the consideration of efficiency and equity criteria. To demonstrate the applicability of the proposed framework, we used Erie County in the State of New York as a case study. This study could help urban planners determine the optimal locations to add new hospitals, with the hope of improving equitable access to healthcare services.

Access to vaccination against a health threat such as that presented by the COVID-19 pandemic is an imperative driven, in principle, by at least three compelling factors: (1) the right to health of all people, irrespective of their status; (2) humanitarian need of undocumented migrants, as well as of others including documented migrants, refugees and displaced people who are sometimes vulnerable and living in precarious situations; and (3) the need to ensure heath security globally and nationally, which in the case of a global pandemic requires operating on the basis that, for vaccination strategies to succeed in fighting a pandemic, the highest possible levels of vaccine uptake are required. Yet some population segments have had limited access to mainstream health systems, both prior to as well as during the COVID-19 pandemic. People with irregular resident status are among those who face extremely high barriers in accessing both preventative and curative health care. This is due to a range of factors that drive exclusion, both on the supply side (e.g., systemic and practical restrictions in service delivery) and the demand side (e.g., in uptake, including due to fears that personal data would be transmitted to immigration authorities). Moreover, undocumented people have often been at increased risk of infection due to their role as “essential workers”, including those experiencing higher exposure to the SARS-CoV-2 virus due to frontline occupations while lacking protective equipment. Often, they have also been largely left out of social protection measures granted by governments to their populations during successive lockdowns. This article reviews the factors that serve as supply-side and demand-side barriers to vaccination for undocumented migrants and considers what steps need to be taken to ensure that inclusive approaches operate in practice.

It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.

Although the global response to COVID-19 has demonstrated that some progress has been made in ensuring timely access to new medical interventions in Africa, much more needs to be done to strengthen the global systems that enable equitable access to health technologies during public health emergencies. The development of COVID-19 diagnostics, therapeutics and vaccines has been a remarkable technical achievement. By the end of 2021, hundreds of diagnostic tests, including rapid antigen tests enabling self-testing, had received regulatory approval from national authorities. Multiple existing medicines had been repurposed and novel therapeutics had been included in World Health Organization (WHO) guidance for the treatment and prevention of COVID-19.1,2 As at the end of February 2022, 14 WHO emergency use listings had been issued, covering ten vaccine products, and a further five vaccines were under review. 3 However, access to these COVID-19 technologies has been slow and unequal in low- and middle-income countries (LMICs), and particularly in Africa. For example, while vaccine coverage is near universal in many high-income countries, only 10% of the populations in low-income countries have received at least one dose of a COVID-19 vaccine.4 Access has been hampered for a range of reasons. With limited supplies and global manufacturing capacity, manufacturers have prioritised high-income countries paying premium prices. Some countries have also imposed export restrictions on finished vaccines and/or raw materials. Despite modelling showing that, in the medium term, more lives would be saved by equitable global distribution, hoarding of COVID-19 vaccines by high-income countries has been the norm.5 Affordability is a key barrier. The average cost of a dose of COVID-19 vaccine varies between USD2 and USD40, while distribution costs average USD3.70 per double-vaccinated individual. It has been estimated that high-income countries have to increase their health expenditure by 0.8% to vaccinate 70% of their population but low-income countries have to increase it by 56.6%.6 Local obstacles to the introduction of COVID-19 vaccines have also played a role in limiting access. A lack of health system preparedness in countries with weak healthcare systems, as well as limited local evidence, for example on the effectiveness of different vaccines or the nature of circulating strains, has contributed to delayed availability of vaccines, which has contributed to significant vaccine hesitancy in Africa.

Background The 2019 VA Maintaining Systems and Strengthening Integrated Outside Networks Act, or MISSION Act, aimed to improve rural veteran access to care by expanding coverage for services in the community. Increased access to clinicians outside the US Department of Veterans Affairs (VA) could benefit rural veterans, who often face obstacles obtaining VA care. This solution, however, relies on clinics willing to navigate VA administrative processes. Objective To investigate the experiences rural, non-VA clinicians and staff have while providing care to rural veterans and inform challenges and opportunities for high-quality, equitable care access and delivery. Design Phenomenological qualitative study. Participants Non-VA-affiliated primary care clinicians and staff in the Pacific Northwest. Approach Semi-structured interviews with a purposive sample of eligible clinicians and staff between May and August 2020; data analyzed using thematic analysis. Key Results We interviewed 13 clinicians and staff and identified four themes and multiple challenges related to providing care for rural veterans: (1) Confusion, variability and delays for VA administrative processes, (2) clarifying responsibility for dual-user veteran care, (3) accessing and sharing medical records outside the VA, and (4) negotiating communication pathways between systems and clinicians. Informants reported using workarounds to combat challenges, including using trial and error to gain expertise in VA system navigation, relying on veterans to act as intermediaries to coordinate their care, and depending on individual VA employees to support provider-to-provider communication and share system knowledge. Informants expressed concerns that dual-user veterans were more likely to have duplication or gaps in services. Conclusions Findings highlight the need to reduce the bureaucratic burden of interacting with the VA. Further work is needed to tailor structures to address challenges rural community providers experience and to identify strategies to reduce care fragmentation across VA and non-VA providers and encourage long-term commitment to care for veterans.

•Speaking a language other than English or Spanish significantly decreases access to diagnostic genomic research.•Participation in diagnostic genomic research did not generally differ by race and ethnicity.•There exist opportunities at the federal level to improve access to translated short forms, fund research aimed at improving equity, incentivize best practices for inclusive research recruitment, and provide more resources and training to improve research access. Diagnostic genomic research has the potential to directly benefit participants. This study sought to identify barriers to equitable enrollment of acutely ill newborns into a diagnostic genomic sequencing research study. We reviewed the 16-month recruitment process of a diagnostic genomic research study enrolling newborns admitted to the neonatal intensive care unit at a regional pediatric hospital that primarily serves English- and Spanish-speaking families. Differences in eligibility, enrollment, and reasons for not enrolling were examined as functions of race/ethnicity and primary spoken language. Of the 1248 newborns admitted to the neonatal intensive care unit, 46% (n = 580) were eligible, and 17% (n = 213) were enrolled. Of the 16 languages represented among the newborns’ families, 4 (25%) had translated consent documents. Speaking a language other than English or Spanish increased a newborn's likelihood of being ineligible by 5.9 times (P < 0.001) after controlling for race/ethnicity. The main reason for ineligibility was documented as the clinical team declined having their patient recruited (41% [51 of 125]). This reason significantly affected families who spoke languages other than English or Spanish and was able to be remediated with training of the research staff. Stress (20% [18 of 90]) and the study intervention(s) (20% [18 of 90]) were the main reasons given for not enrolling. This analysis of eligibility, enrollment, and reasons for not enrolling in a diagnostic genomic research study found that recruitment generally did not differ as a function of a newborn's race/ethnicity. However, differences were observed depending on the parent's primary spoken language. Regular monitoring and training can improve equitable enrollment into diagnostic genomic research. There are also opportunities at the federal level to improve access to those with limited English proficiency and thus decrease disparities in representation in research participation.

This article introduces the special issue “Advancing Equitable Access to Quality Education Globally: Innovations in Curriculum, Teacher Education, and Professional Development,” featuring articles that report on a multi-country project examining the challenges and opportunities of globalization for three types of reforms that have seen significant innovation in the past decade. These reforms encompass the school curriculum, teachers' education, and teachers' professional development (collectively referred to in this article as SCTEPD). The reporting countries were undergoing rapid transformation that incorporated the three reforms when we began our work, and included: India, New Zealand, Peru, Scotland, and Wales. This introductory article offers a retrospective and prospective discussion of global reforms in three key areas of SCTEPD, providing context for the articles that follow. In this introductory article, we use Cohen and Mehta's (2017) theoretical framework to analyze these reforms, aiming to understand the conditions that lead to successful, lasting reforms and the extent to which these reforms have increased equity and quality in education for all learners.

Inequity in the access to and deployment of the coronavirus disease 2019 (COVID-19) vaccines has brought about great challenges in terms of resolving the pandemic. Aiming to analyze the association between country income level and COVID-19 vaccination coverage and explore the mediating role of vaccination policy, we conducted a cross-sectional ecological study. The dependent variable was COVID-19 vaccination coverage in 138 countries as of May 31, 2021. A single-mediator model based on structural equation modeling was developed to analyze mediation effects in different country income groups. Compared with high-income countries, upper-middle- (β = −1.44, 95% CI: −1.86–−1.02, p < 0.001), lower-middle- (β = −2.24, 95% CI: −2.67–−1.82, p < 0.001), and low- (β = −4.05, 95% CI: −4.59–−3.51, p < 0.001) income countries had lower vaccination coverage. Vaccination policies mediated 14.6% and 15.6% of the effect in upper-middle- (β = −0.21, 95% CI: −0.39–−0.03, p = 0.020) and lower-middle- (β = −0.35, 95% CI: −0.56–−0.13, p = 0.002) income countries, respectively, whereas the mediation effect was not significant in low-income countries (β = −0.21, 95% CI: −0.43–0.01, p = 0.062). The results were similar after adjusting for demographic structure and underlying health conditions. Income disparity remains an important cause of vaccine inequity, and the tendency toward “vaccine nationalism” restricts the functioning of the global vaccine allocation framework. Stronger mechanisms are needed to foster countries’ political will to promote vaccine equity.