32 research outputs found
âExcuse me, I have a deliveryâ The [re] construction of interview âspace' in the Covid-19 pandemic
Get PDF© University of LeedsCovid-19 has transformed the qualitative interview process, as remote video methods have become mainstream, challenging the domination of face-to-face interviews. In the pandemic churn, researchersâ focus was on ensuring participantsâ safety and care in the virtual interview environment. There was more limited consideration of what this ânew normalâ meant for the researcher. This reflection draws on two qualitative research projects conducted during the 2020/2021 pandemic period in the UK. We propose that assumptions of âspaceâ in the qualitative interview process have been (re)constructed in remote interviews during Covid19. To be present virtually creates geographic freedoms of participant access, but subjective risks from interviewing in the virtual space. Context can no longer be understood through the shared experience of an interview space. There is a delineation of what is âpublicâ or âprivateâ as participants and researchers share their domestic spheres. Using ethnographic reflections, we explore the changing notions of geographic, public and private space in the Covid-19
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âExcuse me, I have a deliveryâ The [re] construction of interview âspace' in the Covid-19 pandemic
Get PDFCovid-19 has transformed the qualitative interview process, as remote video methods have become mainstream, challenging the domination of face-to-face interviews. In the pandemic churn, researchersâ focus was on ensuring participantsâsafety and care in the virtual interview environment. There was more limited consideration of what this ânew normalâ meant for the
researcher. This reflection draws on two qualitative research projects conducted during the
2020/2021 pandemic period in the UK. We propose that assumptions of âspaceâ in the qualitative interview process have been (re)constructed in remote interviews during Covid19. To be present virtually creates geographic freedoms of participant access, but subjective
risks from interviewing in the virtual space. Context can no longer be understood through the
shared experience of an interview space. There is a delineation of what is âpublicâ or âprivateâ as participants and researchers share their domestic spheres. Using ethnographic reflections, we explore the changing notions of geographic, public and private space in the Covid-19 interview
A Viral Ubiquitin Ligase Has Substrate Preferential SUMO Targeted Ubiquitin Ligase Activity that Counteracts Intrinsic Antiviral Defence
Get PDFIntrinsic antiviral resistance represents the first line of intracellular defence against virus infection. During herpes simplex virus type-1 (HSV-1) infection this response can lead to the repression of viral gene expression but is counteracted by the viral ubiquitin ligase ICP0. Here we address the mechanisms by which ICP0 overcomes this antiviral response. We report that ICP0 induces the widespread proteasome-dependent degradation of SUMO-conjugated proteins during infection and has properties related to those of cellular SUMO-targeted ubiquitin ligases (STUbLs). Mutation of putative SUMO interaction motifs within ICP0 not only affects its ability to degrade SUMO conjugates, but also its capacity to stimulate HSV-1 lytic infection and reactivation from quiescence. We demonstrate that in the absence of this viral countermeasure the SUMO conjugation pathway plays an important role in mediating intrinsic antiviral resistance and the repression of HSV-1 infection. Using PML as a model substrate, we found that whilst ICP0 preferentially targets SUMO-modified isoforms of PML for degradation, it also induces the degradation of PML isoform I in a SUMO modification-independent manner. PML was degraded by ICP0 more rapidly than the bulk of SUMO-modified proteins in general, implying that the identity of a SUMO-modified protein, as well as the presence of SUMO modification, is involved in ICP0 targeting. We conclude that ICP0 has dual targeting mechanisms involving both SUMO- and substrate-dependent targeting specificities in order to counteract intrinsic antiviral resistance to HSV-1 infection
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Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.
Get PDFImportance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (nâ=â143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (nâ=â152), or no hydrocortisone (nâ=â108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (nâ=â137), shock-dependent (nâ=â146), and no (nâ=â101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707
Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19
Get PDFIMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19.
Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19.
DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 nonâcritically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022).
INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (nâ=â257), ARB (nâ=â248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; nâ=â10), or no RAS inhibitor (control; nâ=â264) for up to 10 days.
MAIN OUTCOMES AND MEASURES The primary outcome was organ supportâfree days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes.
RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ supportâfree days among critically ill patients was 10 (â1 to 16) in the ACE inhibitor group (nâ=â231), 8 (â1 to 17) in the ARB group (nâ=â217), and 12 (0 to 17) in the control group (nâ=â231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ supportâfree days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively).
CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570
Towards a humanitarian logistics knowledge management system
No full textPaper Classification Conceptual Paper Abstract Purpose The aim of this paper is to offer a conceptual model and an associated taxonomy to support the development of a body of knowledge in support of the logistic response to a natural or man-made disaster. Design/Methodology/Approach Based on a literature review, the paper outlines the difficulties associated with the logistic response to a disaster, before discussing a generic approach to knowledge management. The literature review is then used to identify two potential models (the Supply-Chain Operations Reference (SCOR) and the UK Defence Lines of Development (LOD)) that are then further developed and integrated in order to underpin a knowledge taxonomy. Findings The paper proposes a model that combines both the SCOR and LOD models into a unified approach as a first step towards the development of a broad ranging reference source to support humanitarian logisticians and, thereby, improve the effectiveness and efficiency of the response to future disasters. Research Limitations As a first step towards the creation of a knowledge taxonomy, this conceptual paper, does not attempt to validate the model, but it proposes an approach by which this could be undertaken. Practical Implications Given the plethora of non-governmental organisations (NGOs) in the broadest sense of this categorisation, and also recognising the varied nature of their aims, objectives and approaches, the paper pays particular attention to the need to develop a model that can be supported by the NGO community as a whole. Key Words Humanitarian logistics, Knowledge management, Knowledge taxonomy, Supply network management, Supply chain managementGriffith Business School, Department of International Business and Asian StudiesFull Tex
Cracking the humanitarian logistic coordination challenge: some pointers from the International Search and Rescue Advisory Group and the Foreign Medical Teams
No full textAt a recent humanitarian logistic conference (June 2013), one of the delegates -a practitioner with many years' experience -observed that the ideal response would have a number of attributes. It would be: planned, coordinated, consistent and adaptive. However, by common consent, humanitarian logistic (HL) activities in the preparation for, and aftermath of, natural disasters and complex emergencies currently fail to achieve excellence in respect of some or all of the above characteristics. By comparison, the organizations that form part of the international search and rescue community demonstrate a significantly greater ability to deliver against these four criteria, and it is suggested that their approach has the potential to offer useful pointers that will assist the HL community in improving the efficiency and effectiveness of its operations.
This chapter will, therefore, explore the processes and procedures used by the International Search and Rescue Advisory Group (INSARAG) and their applicability to the HL context. In doing so, it will also draw on the emerging approach of the Foreign Medical Teams that are using a modified version of the search and rescue model which reflects their particular context. By considering the challenges to the delivery of a similar modus operandi, a number of key issues facing the HL community are exposed, and some tentative solutions offered.Griffith Business School, Department of International Business and Asian StudiesNo Full Tex
an analysis of lessons identified using an adapted military planning framework
Get PDFThe United Kingdom uses the Defence Lines of Development (DLOD) framework to analyse and understand the key components and costs of a military capability. Rooted in the Resource Based View (RBV) of a firm, an adapted DLOD approach is employed to explore, analyse and discuss the preparedness, planning and response strategies of two markedly different countries (Australia and Bangladesh) when faced with a major cyclone event of a comparable size. Given the numerous similarities in the challenges facing military forces in a complex emergency and humanitarian agencies in a natural disaster, the paper demonstrates the applicability of the DLOD framework as an analysis and planning tool in the cyclone preparedness planning and response phases, and more broadly within the disaster management area. In addition, the paper highlights the benefit to disaster managers, policymakers and researchers of exploiting comparative cross-learning opportunities from disaster events, drawn from different sectors and countries
Situational Awareness: A core component in the development of a humanitarian common logistic operating picture
No full textAbstract The onset of a natural disaster or complex emergency frequently sees multiple agencies responding in a relatively uncoordinated way. One potential solution is that of developing a 'Humanitarian Common Logistic Operating Picture' (H-CLOP) that would capture, analyse, validate, distribute and present the disposition of both existing and forecast demands, and the status and location of material in transit as the basis for improved inter-agency logistic decision making. This paper considers the challenges inherent in the development of 'situational awareness' as a core component of the H-CLOP concept, and it highlights a number of areas for further research. Keywords: Humanitarian logistics; humanitarian common logistic operating picture; inter agency coordination; situational awareness Topic: Humanitarian operations and crisis management Methodology: Theory and/or research framework Introduction There is a growing recognition that achieving an improved logistic response in the preparation for, and response to, natural disasters and complex emergencies has the potential both to save lives and/or reduce the impact on those affected, as well as allowing donated funds to be spent more efficiently and effectively Within the HL literature, and indeed more broadly within that relating to the general field of emergency management, there is a clear recognition that the achievement of successful inter-agency coordination is a huge challenge (see, for example, Capucu
Cyclones in Bangladesh: a case study of a whole country response to rapid onset disasters
No full textBangladesh, a densely populated country that is frequently beset by natural disasters, has been struck by three major cyclones in the past 37 years â but the resultant loss of life has diminished 100-fold (from some 300,000 in 1970 to around 4,000 in 2007). This bald statistic alone indicates that the Government of Bangladesh, together with a range of UN agencies and national and international NGOs, has developed an effective strategy that encompasses both disaster preparedness and response activities. This paper utilises the UK âDefence Lines of Developmentâ model to analyse this strategy, and to identify key lessons that may be transferable to similar disasters such as the 2008 Cyclone Nargis in Myanmar/Burma that is estimated to have killed up to 1,000,000 people
