bluuebunny/crossref_metadata_2025_split huggingface dataset:
Taking a policy process approach to illuminate the political nature of disability policymaking
Authors: Giordono Leanne 
Published: March 2021

Background: In an era of increased polarisation, identity politics and growing reliance on using evidence to make disability policy decisions – evidence-based policymaking – how much do we know about the process by which disability policy decisions are made and the use of evidence therein?
Aims and objectives: The objective of this Practice Paper is to introduce key policy process frameworks, highlight connections between models of disability and the policy process, and identify opportunities for disability scholars, analysts and advocates to use a policy process approach.
Key conclusions: Wider use of policy process frameworks can enhance our understanding of the political nature of the disability policy decision-making process and conditions that influence how evidence is used to inform disability policy.
Drawing hidden figures of disability: youth and adults with disabilities in Canada
Authors: Prince Michael J. 
Published: March 2021

Background: While governments draw on survey data to inform policy choices, the design, application, and interpretation of surveys can generate certain images of disability and ignore many others.
Aims and objectives: This article draws attention to social circumstances of people with disabilities often unacknowledged in research evidence: hidden figures of disability.
Methods: Selected results from the Canadian Survey on Disability are examined with a focus on working-age youth and adults (aged 15 to 64) with a range of disabilities.
Findings: Five figures of disability and corresponding conceptual models are identified. These hidden figures of disability are the uncounted, those with needs unsupported, youth in multiple transitions, potential workers, and what may be called ‘the fearful’. Several models of disability are identified intersecting with the evidence. These are the absent citizen, biomedical model and charitable model, social and economic integration model, human rights and full citizenship, and psycho-emotional model of affective disablism and ableism.
Discussion: Hidden figures of disability are more than statistical tests and texts; more than calculations derived from quantitative research where people become a data point. The function of drawing hidden figures is to disclose and describe the bodily experiences of people with disabilities in their social positions and structural contexts.
Conclusion: We need to see the production of evidence for policy not as painting a portrait but as portraits in the plural, and appreciate not only what is in the frame but also what faces and forms of knowledge get glossed over or brushed aside.
Generation of optically synchronized pump–signal beams for ultrafast OPCPA via the optical Kerr effect
Authors: Alexandridi Christina , Délen Xavier , Druon Frederic , Georges Patrick , Martin Luc , Mathieu François , Papadopoulos Dimitris 
Published: March 2021

In recent years, multi-petawatt laser installations have achieved unprecedented peak powers, opening new horizons to laser–matter interaction studies. Ultra-broadband and extreme temporal contrast pulse requirements make optical parametric chirped pulse amplification (OPCPA) in the few-picosecond regime the key technology in these systems. To guarantee high fidelity output, however, OPCPA requires excellent synchronization between pump and signal pulses. Here, we propose a new highly versatile architecture for the generation of optically synchronized pump–signal pairs based on the Kerr shutter effect. We obtained

>

550

µ

J

pump pulses of 12 ps duration at 532 nm optically synchronized with a typical ultrashort CPA source at 800 nm. As a proof-of-principle demonstration, our system was also used for amplification of

∼

20

µ

J

ultra-broadband pulses based on an OPCPA setup.
Variation in HIV care and treatment outcomes by facility in South Africa, 2011–2015: A cohort study
Authors: Bor Jacob , Gage Anna , Onoya Dorina , Maskew Mhairi , Tripodis Yorghos , Fox Matthew P. , Puren Adrian , Carmona Sergio , Mlisana Koleka , MacLeod William 
Published: March 2021

Background
Despite widespread availability of HIV treatment, patient outcomes differ across facilities. We propose and evaluate an approach to measure quality of HIV care at health facilities in South Africa’s national HIV program using routine laboratory data.

Methods and findings
Data were extracted from South Africa’s National Health Laboratory Service (NHLS) Corporate Data Warehouse. All CD4 counts, viral loads (VLs), and other laboratory tests used in HIV monitoring were linked, creating a validated patient identifier. We constructed longitudinal HIV care cascades for all patients in the national HIV program, excluding data from the Western Cape and very small facilities. We then estimated for each facility in each year (2011 to 2015) the following cascade measures identified a priori as reflecting quality of HIV care: median CD4 count among new patients; retention 12 months after presentation; 12-month retention among patients established in care; viral suppression; CD4 recovery; monitoring after an elevated VL. We used factor analysis to identify an underlying measure of quality of care, and we assessed the persistence of this quality measure over time. We then assessed spatiotemporal variation and facility and population predictors in a multivariable regression context.
We analyzed data on 3,265 facilities with a median (IQR) annual size of 441 (189 to 988) lab-monitored HIV patients. Retention 12 months after presentation increased from 42% to 47% during the study period, and viral suppression increased from 66% to 79%, although there was substantial variability across facilities. We identified an underlying measure of quality of HIV care that correlated with all cascade measures except median CD4 count at presentation. Averaging across the 5 years of data, this quality score attained a reliability of 0.84. Quality was higher for clinics (versus hospitals), in rural (versus urban) areas, and for larger facilities. Quality was lower in high-poverty areas but was not independently associated with percent Black. Quality increased by 0.49 (95% CI 0.46 to 0.53) standard deviations from 2011 to 2015, and there was evidence of geospatial autocorrelation (p < 0.001). The study’s limitations include an inability to fully adjust for underlying patient risk, reliance on laboratory data which do not capture all relevant domains of quality, potential for errors in record linkage, and the omission of Western Cape.

Conclusions
We observed persistent differences in HIV care and treatment outcomes across South African facilities. Targeting low-performing facilities for additional support could reduce overall burden of disease.
Boosting understanding of Lassa Fever virus epidemiology: Field testing a novel assay to identify past Lassa Fever virus infection in blood and oral fluids of survivors and unexposed controls in Sierra Leone
Authors: Akpogheneta Onome , Dicks Steve , Grant Donald , Kanneh Zainab , Jusu Brima , Edem-Hotah Joseph , Kanneh Lansana , Alhasan Foday , Gbakie Michael , Schieffelin John , Ijaz Samreen , Tedder Richard , Bower Hilary 
Published: March 2021

Background
Despite identification 50 years ago, the true burden of Lassa Fever (LF) across Africa remains undefined for reasons including research focus on hospitalised patients, lack of validated field-feasible tools which reliably identify past infection, and the fact that all assays require blood samples making large-scale surveys difficult. Designated a priority pathogen of epidemic potential requiring urgent research by the World Health Organisation, a better understanding of LF sero-epidemiology is essential to developing and evaluating new interventions including vaccines. We describe the first field testing of a novel species-neutral Double Antigen Binding Assay (DABA) designed to detect antibodies to LF in plasma and oral fluid.

Methodology/Principal findings
Paired plasma and oral fluid were collected in Sierra Leone from survivors discharged from Kenema Government Hospital Lassa Fever Unit between 1980 and 2018, and from controls recruited in Freetown in 2019. Epidemiological sensitivity and specificity of the DABA measured against historical diagnosis in survivors and self-declared non-exposed controls was 81.7% (95% CI 70.7%– 89.9%) and 83.3% (72.7%- 91.1%) respectively in plasma, and 71.8% (60.0%– 81.9%) and 83.3% (72.7%– 91.1%) respectively in oral fluid. Antibodies were identified in people infected up to 15 years and, in one case, 40 years previously. Participants found oral fluid collection easy and painless with 80% happy to give an oral fluid sample regularly.

Conclusions/Significance
Given the difficulties of assay validation in a resource-limited setting, including unexpected exposures and diagnostics of varying accuracy, the new assay performed well in both plasma and oral fluid. Sensitivity and specificity are expected to be higher when case/control ascertainment is more definitive and further work is planned to investigate this. Even at the performance levels achieved, the species-neutral DABA has the potential to facilitate the large-scale seroprevalence surveys needed to underpin essential developments in LF control, as well as support zoonotic investigations.
Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study
Authors: Feldman Oren , Samuel Nir , Kvatinsky Noa , Idelman Ravit , Diamand Raz , Shavit Itai 
Published: March 2021

Background
In the prehospital setting, endotracheal intubation (ETI) may be required to secure the coronavirus disease 2019 (COVID-19) patient airway. It has been suggested that the use of a protective barrier can reduce possible aerosol delivery from patients to clinicians during ETI. We sought to assess the performance of ETI by paramedics wearing personal protective equipment with and without the use of a box barrier.

Methods
A randomized, crossover simulation study was performed in a simulation laboratory. Study participants were 18 paramedics actively working in the clinical environment. Participants’ performance of ETI via direct laryngoscopy (DL) with and without the use of a box barrier was assessed. The sequence of intubation was randomized to either BoxDL-first or DL-first. The primary outcome was the success rate of ETI on first-attempt. The secondary and tertiary outcomes were ETI success rates on three attempts and total intubation time, respectively.

Results
There were no differences between the DL group and the BoxDL group in one-attempt success rates (14/18 vs 12/18; P = 0.754), and in overall success rates (16/18 vs 14/18; P = 0.682). The mean (standard deviation) of the total intubation times for the DL group and the BoxDL group were 27.3 (19.7) seconds and 36.8 (26.2) seconds, respectively (P < 0.015).

Conclusions
The findings of this pilot study suggest that paramedics wearing personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID-19 patients remain to be investigated.
Does social health insurance prevent financial hardship in Mongolia? Inpatient care: A case in point
Authors: Dorjdagva Javkhlanbayar , Batbaatar Enkhjargal , Svensson Mikael , Dorjsuren Bayarsaikhan , Togtmol Munkhsaikhan , Kauhanen Jussi 
Published: March 2021

Background
Protecting people from financial hardship and impoverishment due to health care costs is one of the fundamental purposes of the Mongolian health system. However, the inefficient, oversized hospital sector is considered one of the main shortcomings of the system. The aim of this study is to contribute to policy discussions by estimating the extent of catastrophic health expenditure and impoverishment due to inpatient care at secondary-level and tertiary-level public hospitals and private hospitals.

Methods
Data were derived from a nationally representative survey, the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. A total of 12,685 households were involved in the study. “Catastrophic health expenditure” is defined as out-of-pocket payments for inpatient care that exceed a threshold of 40% of households’ non-discretionary expenditure. The “impoverishment” effect of out-of-pocket payments for inpatient care was estimated as the difference between the poverty level before health care payments and the poverty level after these payments.

Results
At the threshold of 40% of capacity to pay, 0.31%, 0.07%, and 0.02% of Mongolian households suffered financially as a result of their member(s) staying in tertiary-level and secondary-level public hospitals and private hospitals respectively. About 0.13% of the total Mongolian population was impoverished owing to out-of-pocket payments for inpatient care at tertiary-level hospitals. Out-of-pocket payments for inpatient care at secondary-level hospitals and private hospitals were responsible for 0.10% and 0.09% respectively of the total population being pushed into poverty.

Conclusions
Although most inpatient care at public hospitals is covered by the social health insurance benefit package, patients who utilized inpatient care at tertiary-level public hospitals were more likely to push their households into financial hardship and poverty than the inpatients at private hospitals. Improving the hospital sector’s efficiency and financial protection for inpatients would be a crucial means of attaining universal health coverage in Mongolia.
Understanding how and why audits work in improving the quality of hospital care: A systematic realist review
Authors: Hut-Mossel Lisanne , Ahaus Kees , Welker Gera , Gans Rijk 
Published: March 2021

BackgroundSeveral types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care.MethodsA realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context–mechanism–outcome configurations (CMOcs).ResultsFrom our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration.ConclusionsThis realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts.PROSPERO registrationCRD42016039882.
Seroprevalence of COVID-19 infection in a rural district of South India: A population-based seroepidemiological study
Authors: Inbaraj Leeberk Raja , George Carolin Elizabeth , Chandrasingh Sindhulina 
Published: March 2021

Objectives
We aimed to estimate the seroprevalence of COVID-19 in a rural district of South India, six months after the index case.

Methodology
We conducted a cross-sectional study of 509 adults aged more than 18 years. From all the four subdistricts, two grampanchayats (administrative cluster of 5–8 villages) were randomly selected followed by one village through convenience. The participants were invited for the study to the community-based study kiosk set up in all the eight villages through village health committees. We collected socio-demographic characteristics and symptoms using a mobile application-based questionnaire, and we tested samples for the presence of IgG antibodies for SARS CoV-2 using an electro chemiluminescent immunoassay. We calculated age-gender adjusted and test performance adjusted seroprevalence.

Results
The age-and gender-adjusted seroprevalence was 8.5% (95% CI 6.9%- 10.8%). The unadjusted seroprevalence among participants with hypertension and diabetes was 16.3% (95% CI:9.2–25.8) and 10.7% (95% CI: 5.5–18.3) respectively. When we adjusted for the test performance, the seroprevalence was 6.1% (95% CI 4.02–8.17). The study estimated 7 (95% CI 1:4.5–1:9) undetected infected individuals for every RT-PCR confirmed case. Infection Fatality Rate (IFR) was calculated as 12.38 per 10000 infections as on 22 October 2020. History of self-reported symptoms and education were significantly associated with positive status (p < 0.05)

Conclusion
A significant proportion of the rural population in a district of south India remains susceptible to COVID-19. A higher proportion of susceptible, relatively higher IFR and a poor tertiary healthcare network stress the importance of sustaining the public health measures and promoting early access to the vaccine are crucial to preserving the health of this population. Low population density, good housing, adequate ventilation, limited urbanisation combined with public, private and local health leadership are critical components of curbing future respiratory pandemics.
Using graphic modelling to identify modifiable mediators of the association between area-based deprivation at birth and offspring unemployment
Authors: Bogie James , Fleming Michael , Cullen Breda , Mackay Daniel , Pell Jill P. 
Published: March 2021

Background
Deprivation can perpetuate across generations; however, the causative pathways are not well understood. Directed acyclic graphs (DAG) with mediation analysis can help elucidate and quantify complex pathways in order to identify modifiable factors at which to target interventions.

Methods and findings
We linked ten Scotland-wide databases (six health and four education) to produce a cohort of 217,226 pupils who attended Scottish schools between 2009 and 2013. The DAG comprised 23 potential mediators of the association between area deprivation at birth and subsequent offspring ‘not in education, employment or training’ status, covering maternal, antenatal, perinatal and child health, school engagement, and educational factors. Analyses were performed using modified g-computation. Deprivation at birth was associated with a 7.3% increase in offspring ‘not in education, employment or training’. The principal mediators of this association were smoking during pregnancy (natural indirect effect of 0·016, 95% CI 0·013, 0·019) and school absences (natural indirect effect of 0·021, 95% CI 0·018, 0·024), explaining 22% and 30% of the total effect respectively. The proportion of the association potentially eliminated by addressing these factors was 19% (controlled direct effect when set to non-smoker 0·058; 95% CI 0·053, 0·063) for smoking during pregnancy and 38% (controlled direct effect when set to no absences 0·043; 95% CI 0·037, 0·049) for school absences.

Conclusions
Combining a DAG with mediation analysis helped disentangle a complex public health problem and quantified the modifiable factors of maternal smoking and school absence that could be targeted for intervention. This study also demonstrates the general utility of DAGs in understanding complex public health problems.
O embate do encontro: o currículo cultural da educação física como lugar de conflitos
Authors: Machado de Castro Silva Fidel , Nunes Mário 
Published: March 2021

O embate do encontro: o currículo cultural da educação física como lugar de conflitos
Resumo: Neste artigo, tenciona-se aproximar, problematizar e refletir sobre a relação entre duas divindades gregas: Dionísio e Apolo - e o Currículo Cultural da Educação Física. Buscamos amparo metodológico na criação filosófico conceitual, pois sua utilização pode redesenhar relações estabelecidas e permitir jogar com elementos distintos e, inicialmente, não aproximáveis. Influenciados por Dionísio, ao final, trazemos duas criações pedagógicas a fim de transgredir os limites dados pelo "excesso de Apolo" na escrita acadêmica.Palavras-chave: Educação Física; Currículo Cultural; Filosofia.
The fight of the meeting: the curriculum of physical education as a place of conflicts
Abstract: In this article, we intend to approximate the relationship between two Greek deities: Dionysus and Apollo - and the Cultural Curriculum of Physical Education. We seek methodological support in the conceptual philosophical creation, as its use can redesign established relationships and allow us to play with different and, initially, not approximable elements. Influenced by Dionísio, at the end, we bring two pedagogical creations in order to transgress the limits given by the "excess of Apollo" in academic writing.Keywords: Physical Education; Cultural Curriculum; Philosophy.
La lucha de la reunión: el currículo cultural de la educación física como lugar de conflictos
Resumén: En este artículo, tenemos la intención de aproximar la relación entre dos deidades griegas: Dioniso y Apolo, y el Currículo Cultural de Educación Física. Buscamos apoyo metodológico en la creación filosófica conceptual, ya que su uso puede rediseñar las relaciones establecidas y nos permite jugar con elementos diferentes e, inicialmente, no aproximables. Influenciado por Dionísio, al final, traemos dos creaciones pedagógicas para transgredir los límites dados por el "exceso de Apolo" en la escritura académica.Palabras clave: Educación Física; Curriculum Cultural; Filosofia
Data de registro: 02/03/2020Data de aceite: 05/08/2020