Central West Research Articles

An initiative to develop a public engagement ecosystem in Ghana: a case of WACCBIP’s High Schools’ Engagement Programme

Background: The High Schools Engagement Programme (HSEP), is a West African Centre for Cell Biology of Infectious Pathogens (WACCBIP) public engagement initiative that targets students in under-resourced high schools in Ghana. Annual programmes are directed towards providing information on prospective careers in Science and discussing the causes of and preventive measures against endemic infectious diseases. Using peer-learning strategies, post-undergraduate research trainees (graduate interns) encourage collective action against the diseases and work to inspire high school students to consider scientific research as a career, either directly or in support roles. The objective of this study was to explore the outcomes of the HSEP, specifically revealing how it met its initial objectives, and other relevant unintended outcomes. Methods: An evaluation design, which relied on a survey and interviews of 138 high school students, 9 graduate interns, and 3 teachers who participated in the 2019 edition of the HSEP, was employed. Results: The HSEP presented a likelihood of improving the academic performance of high school students and provided motivation for them to pursue careers in scientific research. The programme also equipped the students with requisite knowledge to contribute to the prevention of infectious diseases prevalent in their communities. As trainee scientists, graduate interns also developed awareness on the need for public engagement, the challenges of STEM education in Ghana and the need to make efforts to address these challenges, and also developed key leadership and soft skills. Conclusions: Overall, the HSEP could potentially be a model for developing a public engagement ecosystem in Ghana. It is recommended that the programme is scaled up to include master’s degree and PhD researchers as facilitators to further widen the favorable impacts.

Nature, characterization and resource potential of littoral placer deposits of Goa, central west coast of India

Nature, characterization and resource potential of littoral placer deposits of Goa, central west coast of India

Differential Symbiodiniaceae Association With Coral and Coral-Eroding Sponge in a Bleaching Impacted Marginal Coral Reef Environment

Marginal reefs are known for severe stress-inducible perturbations such as high sedimentation, eutrophication, ocean warming, and acidification from anthropogenic climate change. The corals striving in such stressful environments develop physiological adaptations induced by differential genomic expressions or association with thermal stress-tolerant algal symbionts (Symbiodiniaceae). Despite such adaptations, corals are threatened by other space competitors such as algae and sponges. Coral-eroding sponges belonging to the Cliona viridis complex are one such space competitors that also associate with Symbiodiniaceae algal photosymbiont. The diversity of Symbiodiniaceae associates with the coral and sponge from the same ecosystems is scarcely known. In the present study, Symbiodiniaceae community structure in the coral Turbinaria mesenterina, a newly described coral-eroding sponge Cliona thomasi, and their surrounding seawater was determined from the nearshore marginal reef along the central west coast of India. The results revealed a significantly higher relative abundance of Durusdinium and Gerakladium than Symbiodinium and Cladocopium in the seawater. Interestingly, both investigated host species showed differential Symbiodiniaceae association with significantly higher abundance of Durusdinium in coral and Gerakladium in sponge. The beta diversity analysis by Permutational multivariate analysis of variance (PERMANOVA) confirmed significant differences in Symbiodiniaceae profiles between sponge and coral. Durusdinium and Gerakladium are thermotolerant genera known to associate with different hosts in suboptimal conditions. Our field surveys suggested the bleaching resistance of the coral T. mesenterina despite the fact that the sea surface temperature reached the coral thermal threshold of 31°C during different periods of the years 2015, 2016, 2017, 2018, and 2019. Therefore, the thermal tolerance of the investigated coral and sponge species may be attributed to their respective thermotolerant photosymbiont associations. Furthermore, the results also indicated the host-specific photosymbiont selection from the local environment. Although these observations provide valuable biological insight, more research is needed to understand the tripartite association of sponge-coral-symbiont together to evaluate the competitive fitness of holobionts.

Hubungan Pengetahuan dan Sikap Ibu Hamil dengan Perilaku Pencegahan Covid–19 dalam Adaptasi Kebiasaan Baru

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Based on data from the Lampung Provincial Health Office (2020), four patients who are pregnant have been confirmed positive for COVID-19. At Gilang Tunggal Makarta Public Health Center of West Tulangbawang Regency (2020) there is 1 pregnant woman aged 22 years old and who has a history of having travelled from DKI Jakarta to be confirmed positive for COVID-19. The purpose of this research is to know the correlation between knowledge and pregnant women attitudes with covid-19 prevention behaviours on new habits adaptation in the working area of Gilang Tunggal Makarta Public Health Center West TulangBawang Regency in 2021. This type of research is quantitative by applying an analytic research design with a cross-sectional approach, the population is all pregnant women as many as 34 people, the total sample size from the population. Univariate data analysis used a percentage frequency distribution and bivariate used the chi-square test. The research result showed that the frequency distribution of pregnant women knowledge was higher in the unfavourable category as many 20 people (58.8%), the pregnant women attitude were higher in the negative category as many as 19 people (55.9%) and the prevention behaviour of COVID-19 was higher in the unfavourable category amounted to 21 people (61.8%). The results of the chi-square test showed a correlation between knowledge (p-value = 0.000 0.05) and behavior (p-value = 0.001 0.05) with COVID-19 prevention behavior on new habits adaptation. It is hoped that health workers will be more active in socializing COVID-19 prevention behaviour through direct counselling on demonstration methods accompanied by discussion using leaflets or brochures using interesting pictures and writing also using simple language.

A Global Tropical Survey of Mid-Tropospheric Cyclones

AbstractMid-Tropospheric Cyclones (MTCs) are moist synoptic systems with distinct mid-tropospheric vorticity maxima and weak signatures in the lower troposphere. Composites and statistics of tropical MTCs are constructed and compared with monsoon lows and depressions (together, lower troposphere cyclones; LTCs). We begin with South Asia, where tracking reveals that MTCs change character during their life, i.e., their track is composed of MTC and LTC phases. The highest MTC-phase density and least motion is over the Arabian Sea, followed by the Bay of Bengal and the South China Sea. An MTC-phase composite shows an east-west tilted warm above deep cold-core temperature anomaly with maximum vorticity at 600 hPa. In contrast, the LTC-phase shows a shallow cold-core below 800 hPa and a warm upright temperature anomaly with a lower tropospheric vorticity maximum. Globally, systems with MTC-like morphology are observed over the west and central Africa, east and west Pacific in boreal summer. In boreal winter, regions that support MTCs include northern Australia, the southern Indian Ocean, and South Africa. MTC fraction is higher equatorward where there is a cross-equatorial low-level jet that advects oppositely signed vorticity. Whereas LTCs are more prevalent further poleward. Finally, a histogram of differential vorticity (the difference between middle and lower levels) versus the height of peak vorticity for cyclonic centers is shown to be bimodal. One peak, around 600 hPa, corresponds to MTCs, while the second, at approximately 900 hPa, comes from LTCs. Thus, moist cyclonic systems in the tropics have a natural tendency to reside in either the MTC or LTC category.

Prevalence, associated factors and prevention of burnout in psychiatry trainees in Central and North West London NHS Foundation Trust

AimsTo assess burnout, resilience, professional quality of life and coping mechanisms in Central and North West London psychiatry traineesObjectivesTo determine Key factors associated with stress and burnout in workplace Effects of burnout on patient care and doctors Coping mechanisms used by traineesBackgroundBurnout is a well established condition that has been recently reported to affect a third of doctors. Psychiatrists in particular represents a high risk group among doctors for experiencing burnout, alcohol and drug use, posing suicide risk and other forms of work related stress.MethodThe study comprised of a cross sectional questionnaire survey which included measure of stress (General Health Questionnaire), burnout (Maslach Burnout Inventory), and satisfaction with medicine as a career and personality (Big Five). During October to December 2019, core trainee and specialty trainee doctors in CNWL were asked to complete an online survey via emails.ResultWe collected data from 50 CNWL psychiatry trainees. The sample consisted of 20 females (40%) and 30 males (60%). Ages varied from 26–58 years old, with a median age of 28. Core trainees (CT1–3) were recorded as 72% and specialty trainees at 28%.Of those who responded, around half of the trainees (52%) experienced high levels of stress outside of work in their personal life. The most common causes that trainees felt makes psychiatry a stressful profession were violence and fear of violence, limited resources, dealing with confrontational patients, inability to affect systemic change and increasing culture of blame. Around half of respondents (54%) felt that they have experienced burnout but only 26% of respondents knew where to go to find resources to help cope with burnout. Physical exercise and speaking to colleagues were the most common coping mechanisms used by trainees to deal with stress.Free text responses on what can be improved in workplace to enhance a positive experience of work included improving multidisciplinary interactions, easily accessible resources and increasing staffing levels. 74% of respondents felt they continued to care about what happens to patients regardless of working conditions.ConclusionHalf of CNWL trainee doctors who responded have experienced burnout. Some factors associated with stress and burnout in doctors are unique to psychiatry profession. Free text responses were useful in identifying areas for improvement in work places and useful coping mechanisms, which can be used to inform prevention and implement interventions to tackle burnout.

Improving training and support by improving our out of hours handover, Central and North West London NHS Foundation Trust

AimsDuring out of hour handovers at St Charles Hospital – the two duty SHO (senior house officers) cover on site, whereas the on-call registrar and consultant are available to contact by phone. Some trainees may experience difficulties in contacting their seniors for support, or may not feel comfortable doing so. Trainees may also feel like they would benefit from being more informed of the hospital situation, or added learning and educational opportunities from the shift. The aim of this project was to improve the out of hours support for the on-call SHOs – which we hope to have positive short (such as improving confidence and performance) - and longer-term impacts (improving retention in the deanery and specialty).MethodThe project proposed instating a 15-minute Zoom call at the start of each night shift (9:30pm) which involved the on-call team (SHOs, registrar, consultants and ideally bed managers). Firstly – a survey monkey questionnaire was sent to trainees to gain a baseline on how supported/informed/ease and learning opportunities for that shift. The project then piloted three separate Plan Do Study Act cycles of change and collected feedback from trainees after each cycle. Both qualitative feedback and quantitative feedback from trainees were collected in the Likert scale format after each PDSA cycle.ResultResults showed that a key benefit of this call is that any pressing issues can be brought up and addressed. Furthermore, for the benefit of the trainees, generally trainees felt more supported whilst they are on call, and got to know the fellow on call team. In addition, trainees reported feeling more at ease when calling their senior colleagues.ConclusionIt is particularly important for doctors to feel supported and informed during their on call shift, especially in the current climate, where there are fast changes and adaptations taking place due to the pandemic. By adding a short meeting at the beginning of each night shift, doctors in the hospital demonstrated an increase in feeling supported, informed and having educational opportunities during their on call shifts. In the long term, by addressing on call issues and making trainees feel more confident and supported during their shift, is likely to benefit and improve recruitment and retention.

Evaluation of an attention deficit hyperactivity disorder (ADHD) assessment & treatment service

AimsThe Central and North West London NHS Foundation Trust ADHD clinic offers diagnosis and medication stabilisation for adults with ADHD, in preparation for discharge back to GP for continued prescribing and monitoring. Referral waiting time is shortened by efficiently managing the service and soon transfer of care to GP whilst referrals have been increasingly accepted years on years. A snap shot service evaluation was made to understand characteristics of service exploring its strength and areas to improve.MethodAll 115 patients offered in March and April 2019 for an ADHD specialist assessment were sampled from the new electronic patient record SystmOne in use since 1st March 2019.Data were collected forMale & Female ratioAge range distributionClinical Commissioning Group referral sourceClinic attendance characteristicsADHD diagnosis, sub-types and psychiatric comorbidityADHD Medication prescribedFP10 Prescription duration by prescribersPatient data were anonymously encoded into Microsoft Excel Sheet for sorting, counting, summating and illustrating into tables and pie charts.ResultThe male & female ratio of the sample was 6:5 and nearly half were in age range 20-29 years. Majority were referred from Westminster and West London Clinical Commissioning Groups.107 patients completed the assessment, of which 106 were diagnosed as having an adult ADHD.22% of follow-up clinics were cancelled or not attended (DNA) by patients. The majority of the patients (62%) required 1-2 follow-ups before transfer to GP, whilst 8% did not require or want follow-ups either already being on ADHD medication, not wanting medication or having lost to reviews. Only 3% require six or more follow-ups.Majority were reviewed after two- to five-week prescription, the peak being four-weekly.91% of completion to GP were discharged on ADHD medication, majority being singly on Elvanse (48%) and Concerta XL (25%). Discharge without ADHD medication was due to concerns for its addiction, preference on non-medication treatment, intolerance of medication adverse effect or mental health priority treatment.ConclusionCollaboration with GPs for their pre-treatment physical health screening facilitated prompt prescribing initiation on assessment with most discharges taken place after 1-2 follow-ups, enabling service turn-over with short waiting time (6-9 months in 2018/2019). Service expansion for increasing referral uptake is probably feasible from this baseline by appointing additional sessional clinicians and further efficiency management on clinic scheduling & DNA with a target majority likely requiring 1-2 follow-ups with average four-weekly prescribing.

Application of the clustering algorithm to the small and micro industrial companies for mapping regions with k-medoids

The largest segment of national economic actors is the micro and small enterprises (MSEs). The research aims to analyze the number of micro and small companies in Indonesia using data mining techniques to map a cluster. The dataset used consists of three-four records of the central Statistical Bureau (SourceUrl: https:/www.bps.go.id/), composed of the micro and smaller companies in 2017-2019. The k-medoids method is the solution used in cluster mapping. The average number of small and micro enterprises for 2017-2019 is the attribute used. The numbers of clusters were determined with the Davies Bouldin Index method (DBI), where k = 2 is the best value (0.111). In accordance with the results of the cluster (k=2), the label is divided into two (high cluster (clt1) and low group) (clt2). The results of the calculation of k-medoids show that 90% of Indonesia’s area is within the low class. In the high cluster are only Central Java, West Java and East Java. Accuracy, accuracy, reminder and f-measurement parameters are 100% demonstrated in the cluster test results. This mapping can be one of the foundations on which to constantly increase the number of micro and small firms, since the role of MSEs in jobs is extremely important, since it is apparent that MSEs have continued to grow considerably.

Role in the Forest Village Community-Based Forest Management Sustainable Development

The Village Forest Society Institution is present on the basis of the existence of a Joint Community Forest Management (CBFM) program from one form of Corporate Social Responsibility (CSR). This PHBM policy seeks to empower communities around forest areas with managed areas under the authority of Perum Perhutani in the Provinces of Central Java, East Java, West Java and Banten, except for conservation forests which are implemented to provide welfare efforts for forest village communities so that they can participate in enjoying the results. forest production through a sharing system based on SK. Directors of Perum Perhutani No.682 / KPTS / DIR / 2009 concerning Guidelines for Collaborative Forest Resource Management, Law on Forestry, Village Law, and other supporting legislation..The role of LMDH is needed so that the partnership system in PHBM is able to reach forest village communities through an institution that is formed as an institution that receives delegations from the central / regional government in the management of production forests in the area specified in PP No. 72 of 2010 concerning State Forestry Public Company. With the existence of this LMDH, it is ecpected to be able to provide welfare for the communites around the forest and jointly manage forests based on sustainable development, so that the sustainability and availability of forest resources for future generations can be maintained.

Improving patient waiting times and quality of care by arranging access to notes from a neighbouring trust

AimsWe aim to improve waiting times in the Emergency Department and improve the overall quality of care of out-of-area patients by arranging for the liaison team to have access to the electronic notes system of a neighbouring trust.MethodSt Thomas’ Hospital is located in south London, right opposite the City of Westminster. As a result, approximately 20% of patients we see in mental health liaison are from that locality. Given that they belong to a different trust, we do not have access to their notes, which leads to a delay in trying to establish whether they are known to local mental health services. Often, staff are reluctant to divulge information. When information is shared, it is often late and/or incomplete. We approached the Chief Clinical Information Officer and Head of Information Governance from Central and North West London (CNWL) NHS Foundation Trust. We held weekly meetings which included both IT departments. Our IT had to install the electronic notes application (SystmOne) on our computers and open relevant firewall ports. The information is access through an NHS Smartcard, therefore CNWL had to authorise read-only Smartcard profiles for every member of the liaison team. A quick reference guide was created for all staff that would be using the new application. The system went live on 21 January 2021.ResultWe audited patient outcomes in December 2020 and February 2021 for initial comparison. In December 2020, the median time from referral to discharge was 6 hours 35 minutes. 25% of patients were admitted and 17% discharged with HTT. In February 2021, the median time from referral to discharge was 3 hours 19 minutes. 16% of patients were admitted and 5% discharged with HTT.ConclusionIt is likely that by reducing the time required for collateral information, overall waiting times in the emergency department will be reduced. Clinicians are likely to feel more confident in their discharge planning if they have access to all clinical notes and previous risk assessments, which might in turn reduce referrals to HTT or admission. There should be further attempts by neighbouring NHS trusts, especially in London, to ensure access to their electronic notes system in order to reduce waiting times and improve the quality of patient care. We have already been approached for more information by a trust in North London who are interested in establishing access to a neighbouring trust's notes.

Applying ethical dimensions in clinical dilemmas

AimsCentral and North West London's Clinical Ethics Committee (CEC) offers a non-judgmental space to discuss ethical concerns and challenges and provide ethical guidance. This project aims to publicise these ethical dilemmas and guidance to inform decision making trust-wide.BackgroundA Clinical Ethics Committee (CEC) encompasses a diverse range of figures, from psychiatrists and general practitioners to members of the clergy and experts by experience. The CEC in Central and North West London have been meeting regularly since 2003 to provide ethical assistance to a wide range of medical, surgical and psychiatric teams. Complex ethical cases are presented by the treating team, allowing a subsequent discussion of the ethical theories and frameworks within the case with the committee members. This synthesis of information can then assist the treating team in the shaping of ethical based solutions to their dilemmas.The committee wished to encourage ethical based clinical thinking within the trust and enable others to learn from the valuable insights already provided by the CEC over the years.MethodCase notes, recorded from the last 17 years of meetings of the Clinical Ethics Committee were reviewed. 98 cases were identified between 2003-2019. The contemporaneous case reports were then anonymised and indexed into one easy to use file. This file was published on the local intranet and publicised to staff.ResultThe cases were compiled into a PDF document which is available for all staff members within the trust on the intranet. This resource is open to all clinical staff, and serves the dual purpose of encouraging ethical-based thinking and also promoting the ethics committee to those who might be in need of assistance.ConclusionClinical decisions can be complex and nuanced, often complicated by multiple viewpoints and ways of thinking. The database demonstrates the use of ethical dimensions by the ethics committee to inform decision making in a series of varied clinical and management dilemmas. The project required careful consideration around preservation of confidentiality as well as overcoming the logistical barriers of trust-wide dissemination. The result is a document that will allow ethical based decision-making to be embedded into everyday practice.

Black in Immuno ‐ amplifying, celebrating, and supporting Black voices in immunology

Black in Immuno ‐ amplifying, celebrating, and supporting Black voices in immunology

New patterns in China's regional green development: An interval Malmquist–Luenberger productivity analysis

A better understanding of regional differences in green development (GD) is crucial to achieving the sustainability goals in China's high-quality development stage. Data envelopment analysis–based productivity indexes, which link multiple inputs and multiple outputs, have been widely used to evaluate GD. However, most of these models do not take into account the imprecision of regional economic data due to over- or under-reporting by local governments. Here, to alleviate the GD calculation errors due to point estimation as far as possible, we propose a novel global Malmquist–Luenberger productivity index with the interval slacks-based measure to evaluate the provincial green total factor productivity (GTFP) in China from 2000 to 2018. The results showed that the overall GTFP in China during the study period exhibits an increasingly upward trend, accompanied by a declining and converging growth rate in recent years. Moreover, we found an emerging shift in the patterns of inter-regional GTFP from “East–Center–West” to “South–North”, as the differences in the GTFP between the eastern, central and western regions shrink while the gap between the southern and the northern regions expands. A further impact mechanism analysis based on dynamic spatial Durbin panel models revealed that the green development mode in the central, western and northern regions is more exogenously government-dependent, whereas that in the eastern and southern regions is more endogenously market-driven. These findings provide a new reference for optimizing the relationship between the market and government and coordinating the regional green development of China.

Interactions of Large‐Scale Dynamics and Madden‐Julian Oscillation Propagation in Multi‐Model Simulations

AbstractThe underrepresentation of the Madden‐Julian Oscillation (MJO) in climate models remains a challenge, limiting our ability to improve medium‐ to extended‐range atmospheric prediction. Motivated by recent work identifying the importance of the ratio of equatorial Rossby (ER) to Kelvin wave circulations in MJO propagation, this study examines MJO dynamics in 25 climate model simulations. We find that poor MJO models simulate anomalously large ER wave circulations to the west and small Kelvin and ER wave circulations to the east of the convective center. To quantify the role of circulation asymmetries in MJO propagation, we formulate a new west/east (W/E) zonal wind speed ratio. Our W/E ratio differs from other similar metrics in that it implicitly accounts for the ER wave gyres and it can be applied at all levels. Poor model ER wave biases are associated with excessive 700–1000‐hPa convergence, convection, and vertical moisture advection co‐located and west of the convective center while Kelvin and ER wave biases to the east are associated with a weaker dry anomaly and smaller horizontal moisture advection at 450–750‐hPa. Together, these biases help explain the stationary and slight westward MJO propagation in poor models. Space‐time spectral analyses of the zonal wind and precipitation confirm that good models produce realistic power, coherence, and phase for the MJO while poor models vastly underrepresent Kelvin waves and the MJO. Even though Kelvin waves are more realistic in good models, there are still model‐wide biases in circulation‐convection coupling for ER waves and Kelvin waves.

Холодоустойчивый сорт сои северного экотипа Саяна

The cold-resistant soybean cultivar of the northern ecotype Sayana was selected from the hybrid combination F4 L-2577 × Aldana according to the traits of cold and frost resistance and a reduced reaction for a length of a day. Additionally, the degree of cold resistance of this cultivar was evaluated by the cryosedimentation method. The cultivar Sayana belongs to a very early group of ripeness, which matures in 98 days at the latitude of Krasnodar (45°). In the competitive variety test in 2018–2020 its yield amounted to 1.19–2.10 t per ha. During the agroecological testing of the cultivar Sayana in Irkutsk region at a latitude of 53°, the duration of its vegetative period was 126–133 days with the average yield of 2.95 t per ha, which exceeded the standard cultivar Sibiryachka by 0.43 t per ha. The plant height of the cultivar Sayana at the latitude of Krasnodar was 77–88 cm, in the Irkutsk region at latitudes of 53°, it increased to 105–147 cm. The new soybean cultivar of the northern ecotype Sayana is highly resistant to low temperatures of air and soil during the seedling phase, and has increased productivity in long-day conditions of deficient heat supply and cold stress. This allows it to be cultivated as a main crop in the Central Chernozem, Northern Caucasian, Middle Volga, Lower Volga, Ural, West Siberian and East Siberian regions of the Russian Federation.

Consecutive Extratropical Cyclones Daniel, Elsa and Fabien, and Their Impact on the Hydrological Cycle of Mainland Portugal

The extratropical cyclones that originate in the North Atlantic and propagate towards Europe are one of the major natural hazards in mid-latitudes. In December 2019, three consecutive extratropical cyclones named Daniel, Elsa, and Fabien affected Portugal. In this study, the synoptic and upper-level dynamic conditions associated with these systems during their impact in mainland Portugal are evaluated. The persistent intense zonal flow that crossed the entire Atlantic revealed by the integrated vapor transport and the vertically integrated moisture flux favored these hydro-meteorological systems. The patterns of mean sea level pressure, geopotential, potential vorticity, total column water, and convective available potential energy were used to characterize the influence of every system over mainland Portugal. A cluster analysis of monthly precipitation permitted the classification of the country into four main regions named the Northwest, Centre West, Northeast and Centre East, and South region on which the analysis was focused. The three storms affected every region on consecutive days by the middle of December, producing extreme precipitation events and significant effects on the accumulated rainfall and runoff, particularly in the Northwest, Centre West, Northeast and Centre East regions. As consequence, multiple incidences of damage were reported along mainland Portugal. However, an assessment of the Standardized Precipitation Index (SPI) and the Standardized Precipitation–Evapotranspiration Index (SPEI) on time scales of 1, 3, 6, and 12 months revealed a positive impact of rainfall increase on the attenuation of short and long term accumulated drought conditions, particularly in the center and north regions.

How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England

BackgroundStudies have been published regarding the impact of major system change (MSC) on care quality and outcomes, but few evaluate implementation costs or include them in cost-effectiveness analysis (CEA). This is despite large potential costs of MSC: change planning, purchasing or repurposing assets, and staff time. Implementation costs can influence implementation decisions. We describe our framework and principles for costing MSC implementation and illustrate them using a case study.MethodsWe outlined MSC implementation stages and identified components, using a framework conceived during our work on MSC in stroke services. We present a case study of MSC of specialist surgery services for prostate, bladder, renal and oesophagogastric cancers, focusing on North Central and North East London and West Essex. Health economists collaborated with qualitative researchers, clinicians and managers, identifying key reconfiguration stages and expenditures. Data sources (n = approximately 100) included meeting minutes, interviews, and business cases. National Health Service (NHS) finance and service managers and clinicians were consulted. Using bottom-up costing, items were identified, and unit costs based on salaries, asset costs and consultancy fees assigned. Itemised costs were adjusted and summed.ResultsCost components included options appraisal, bidding process, external review; stakeholder engagement events; planning/monitoring boards/meetings; and making the change: new assets, facilities, posts. Other considerations included hospital tariff changes; costs to patients; patient population; and lifetime of changes. Using the framework facilitated data identification and collection. The total adjusted implementation cost was estimated at £7.2 million, broken down as replacing robots (£4.0 million), consultancy fees (£1.9 million), staff time costs (£1.1 million) and other costs (£0.2 million).ConclusionsThese principles can be used by funders, service providers and commissioners planning MSC and researchers evaluating MSC. Health economists should be involved early, alongside qualitative and health-service colleagues, as retrospective capture risks information loss. These analyses are challenging; many cost factors are difficult to identify, access and measure, and assumptions regarding lifetime of the changes are important. Including implementation costs in CEA might make MSC appear less cost effective, influencing future decisions. Future work will incorporate this implementation cost into the full CEAs of the London Cancer MSC.Trial RegistrationNot applicable.

A review of Dendrobium kingianum Bidwill ex Lindl. (Orchidaceae) with morphological and molecular-phylogenetic analyses

Populations of Dendrobium kingianum Bidwill ex Lindl. from near Newcastle, New South Wales to southern and central west Queensland and encompassing all regions of the distribution were studied using field observations, morphometric analysis and nrITS sequences. A total of 281 individuals were used to construct regional descriptions of D. kingianum and 139 individuals were measured for 19 morphological characters, and similarities and differences among specimens summarised using multivariate statistical methods. Patterns of morphological variation within D. kingianum are consistent with a single variable species that expresses clinal variation, with short growing plants in the south and taller plants in the northern part of the distribution. The nrITS gene tree suggests two subgroups within D. kingianum subsp. kingianum, one comprising northern, the other southern individuals, which may overlap in the vicinity of Dorrigo, New South Wales. The disjunct D. kingianum subsp. carnarvonense in central west Queensland, which can be distinguished by a predominately subterranean habit and a narrower labellum midlobe, was resolved sister to D. moorei, which renders D. kingianum paraphyletic in the nrITS gene tree, but this position was not supported. Regional descriptions documenting clinal variation are provided. All previously described varieties, including D. kingianum var. pulcherrimum Rupp, are colour and growth forms of D. kingianum subsp. kingianum.

Epidemiologia da AIDS no Brasil, região Centro-Oeste e Distrito Federal, 2008-2018

Objetivo: Analisar a situação epidemiológica do HIV/AIDS no Brasil, na região Centro-Oeste (CO) e Distrito Federal (DF) entre 2008 e 2018. Métodos: Estudo de caráter quantitativo, observacional e descritivo com dados do Boletim Epidemiológico HIV/AIDS 2019, do Ministério da Saúde, referente aos casos e óbitos por HIV/AIDS entre 2008 e 2018. Resultados: Nos últimos dez anos, a taxa de detecção de AIDS declinou no Brasil (17,9%), no CO (4,4%) e no DF (25,8%). Nesse período, o Brasil passou de 6,2 para 5,3 óbitos/100.000 habitantes e, no CO, de 5,3 para 4,7 óbitos/100.000 hab. Em todo o período, o DF apresentou coeficiente de mortalidade inferior ao nacional, com menor taxa em 2018 (3,6/100.000 hab.). Conclusão: Observa-se queda da taxa de detecção de AIDS e do coeficiente de mortalidade no Brasil, CO e DF.