Care Infrastructure Research Articles

Precision medicine in Australia: now is the time to get it right.

Precision medicine in Australia: now is the time to get it right.

Transfer or tailor? Implementing a technology‐supported intervention for noncommunicable diseases across contexts

Transfer or tailor? Implementing a technology‐supported intervention for noncommunicable diseases across contexts

Neuroaesthetics in Plastic and Reconstructive Surgery: Opportunities for Interdisciplinary Collaboration.

Neuroaesthetics is a burgeoning discipline concerned with the neural basis for the perception and creation of art1 and neuroscientific mechanisms of human aesthetic experiences.2 Research in this field has combined principles of neurology, neuroanatomy, psychology, and art history to answer questions about the experience of beauty.2 Vision has received particularly close attention, especially human perception of faces, paintings, landscapes, and architecture.3 Neuroaesthetics has made meaningful contributions to unraveling neurologic mechanisms underpinning the aesthetic experience, previously regarded as a philosophical concept. Research has demonstrated aesthetic evaluations are important for human activity in consumer behavior, mate selection, and determination of morality.4 The field has identified neuroanatomic structures implicated in the perception of beauty broadly, notably the medial orbital frontal cortex, as well as cortical and subcortical structures specific to certain visual or auditory experiences.2 Within plastic surgery, neuroaesthetics overlaps with the specialty’s goal of characterizing optimal aesthetic outcomes for people. Plastic surgery research on aesthetic preferences may be augmented through collaboration with our colleagues in neuroaesthetics, who offer valuable expertise in neuroscience and aesthetic principles. In return, plastic surgery offers clinical, anatomic, and human aesthetic perspectives that may broaden the neuroaesthetic scope of inquiry. The fields complement one another to enhance the sophistication of questions posed, data generated, and analyses of those data. One example of such a collaboration is the University of Pennsylvania’s Center for Human Appearance, in which neuroaesthetics, plastic surgery, oral surgery, dermatology, oculoplastic surgery, and ear, nose, and throat play key complementary roles in designing studies that enhance understanding of appearance and clinical outcomes. Examples of the center’s initiatives include employing crowdsourcing to compare layperson aesthetic preferences, applying eye-tracking technology to characterize gaze patterns toward visual stimuli, and leveraging face databases to associate character traits to those with facial anomalies.1 Such studies have had an effect on understanding clinical outcomes in aesthetics, craniofacial surgery, and breast surgery. These clinical studies may be augmented with techniques common to the neuroaesthetics toolbox, including functional magnetic resonance imaging or magnetoencephalography to characterize brain activity in response to visual stimuli or convolutional neural networks to learn image features from datasets.5 Other efforts to leverage architectural and artistic principles are also poised to improve health care infrastructure and optimize the patient experience. Plastic surgery has not been regarded as a subdomain of neuroaesthetics inquiry. Plastic surgery would be an asset to the evolution of neuroaesthetics and should seek opportunities to foster relationships with colleagues in this nascent field. This convergence of interests is an exciting opportunity to continue plastic surgery’s history of collaboration to answer unique, multidisciplinary questions with implications for the outcomes of our patients. Disclosure The authors have no financial interest to declare in relation to the content of this article.

Cattle Hotels and Infrastructures of Care

Cattle Hotels and Infrastructures of Care

Emerging Trends: Primary Care Networks Addressing the Workforce Crisis.

To build a resilient, high-performing primary care infrastructure for North Carolina, primary care networks and policymakers should align efforts to create pathways for students, trainees, and new physicians to thrive in primary care. We describe the shifting primary care landscape, current workforce initiatives, and policy options for achieving this goal.

Global Challenges with Oral Antivirals for COVID-19.

Oral antivirals for COVID-19 can be game changers in low- and middle-income countries (LMICs). Challenges that may hinder current and future oral antiviral rollouts span use in special populations, drug-drug and herb-drug interactions, adverse events, development of resistance, black markets, and equity in access and prescribing. Future antivirals may address some of these barriers; however, health systems around the world should be equipped to receive and administer COVID-19 oral antivirals. Improvements in manufacturing capacity, community engagement, capacity for testing and linkage to care, and systems for surveillance and safety monitoring could "change the game" for LMICs, irrespective of any specific antiviral drug. Investments in health care infrastructure can promote resilience, not only for COVID-19 but also for future local and global health crises.

Factors influencing the prioritization of vaccines by policymakers in low- and middle-income countries: a scoping review.

Vaccination decision making in low- and middle-income countries (LMICs) has become increasingly complex, particularly in the context of numerous competing health challenges. LMICs have to make difficult choices on which vaccines to prioritize for introduction while considering a wide range of factors such as disease burden, vaccine impact, vaccine characteristics, financing and health care infrastructures, whilst adapting to each country's specific contexts. Our scoping review reviewed the factors that influence decision-making among policymakers for the introduction of new vaccines in LMICs. We identified the specific data points that are factored into the decision-making process for new vaccine introduction, whilst also documenting whether there have been any changes in decision-making criteria in new vaccine introduction over the last two decades. A comprehensive database search was conducted using a search strategy consisting of key terms and Medical Subject Headings (MeSH) phrases related to policy, decision-making, vaccine introduction, immunization programmes and LMICs. Articles were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 843 articles were identified, with 34 articles retained after abstract screening, full-text screening and grading with the mixed methods appraisal tool (MMAT). The Burchett framework for new vaccine introduction was used to identify indicators for vaccine-decision making and guided data extraction. Articles in our study represented a diverse range of perspectives and methodologies. Across articles, the importance of the disease, which included disease burden, costs of disease and political prioritization, coupled with economic factors related to vaccine price, affordability and financing were the most common criteria considered for new vaccine introduction. Our review identified two additional criteria in the decision-making process for vaccine introduction that were not included in the Burchett framework: communication and sociocultural considerations. Data from this review can support informed decision-making for vaccine introduction amongst policymakers and stakeholders in LMICs.

Experiences With Prenatal Care Delivery Reported by Black Patients With Low Income and by Health Care Workers in the US

Black pregnant people with low income face inequities in health care access and outcomes in the US, yet their voices have been largely absent from redesigning prenatal care. To examine patients' and health care workers' experiences with prenatal care delivery in a largely low-income Black population to inform care innovations to improve care coordination, access, quality, and outcomes. For this qualitative study, human-centered design-informed interviews were conducted at prenatal care clinics with 19 low-income Black patients who were currently pregnant or up to 1 year post partum and 19 health care workers (eg, physicians, nurses, and community health workers) in Detroit, Michigan, between October 14, 2019, and February 7, 2020. Questions focused on 2 human-centered design phases: observation (understanding problems from the end user's perspective) and ideation (generating novel potential solutions). Questions targeted participants' experiences with the 3 goals of prenatal care: medical care, anticipatory guidance, and social support. An eclectic analytic strategy, including inductive thematic analysis and matrix coding, was used to identify promising strategies for prenatal care redesign. Preferences for prenatal care redesign. Nineteen Black patients (mean [SD] age, 28.4 [5.9] years; 19 [100%] female; and 17 [89.5%] with public insurance) and 17 of 19 health care workers (mean [SD] age, 47.9 [15.7] years; 15 female [88.2%]; and 13 [76.5%] Black) completed the surveys. A range of health care workers were included (eg, physicians, doulas, and social workers). Although all affirmed the 3 prenatal care goals, participants reported failures and potential solutions for each area of prenatal care delivery. Themes also emerged in 2 cross-cutting areas: practitioners and care infrastructure. Participants reported that, ideally, care structure would enable strong ongoing relationships between patients and practitioners. Practitioners would coordinate all prenatal services, not just medical care. Finally, care would be tailored to individual patients by using care navigators, flexible models, and colocation of services to reduce barriers. In this qualitative study of low-income, Black pregnant people in Detroit, Michigan, and the health care workers who care for them, prenatal care delivery failed to meet many patients' needs. Participants reported that an ideal care delivery model would include comprehensive, integrated services across the health care system, expanding beyond medical care to also include patients' social needs and preferences.

Lessons Learned from Remote Global Radiation Oncology Education and Training on IMRT for Low- and Middle-Income Countries

<h3>Purpose/Objective(s)</h3> There is a vital need to train radiation oncology professionals in low-and middle-income countries (LMICs) to develop sustainable capacity and infrastructure for clinical oncology care. Radiotherapy departments in LMICs have started to introduce intensity-modulated radiotherapy (IMRT), which is widely utilized in high-income countries and has become the standard of care due to reduced toxicity and improved outcomes in a wide variety of cancers. This work reports on the initiatives and experience with the use of an online training and learning program for global radiation oncology education and training across three LMICs: Uganda, Mongolia and Guatemala <h3>Materials/Methods</h3> Four interactive lectures and four sequential hands-on (step-by-step on IMRT processes) training sessions were given by radiation oncologists and medical physicists at XXX University in XXX, focusing on site-specific target definition, normal tissue contouring, IMRT planning and optimization, and IMRT QA. Additional four weeks of eight online videos and materials developed by XXX were provided to participants to review with quizzes after each week. Pre- and post- surveys, including 10-point confidence scores and free-response questions were performed to evaluate the outcome of the training sessions. Padlet was used as a platform for questions and answers during and after the training sessions. <h3>Results</h3> On average, 37 participants, including 15 radiation oncologists, 11 medical physicists, 5 dosimetrists, and 6 radiation therapists, participated in the virtual training sessions. Eighty percent of the participants responded to the surveys taken immediately following training. 66.7% had not received the IMRT training before. The level of confidence level using IMRT in the clinic increased from 3.25±1.98 to 5.25±2.20. Lessons learned include: 1. Hands-on training sessions are preferred to lectures; 2. Through virtual training, interactions between trainers and trainees are important to engage participants; 3. Different training sessions designed for specific groups (radiation oncologists, medical physicists, radiation therapists and dosimetrists) are needed to improve the relevance; 4. Online self-guided videos are easy to scale up but are a challenge to meet the specific needs of specific groups. 5. Language barrier is one of the limitations to performing the training for non-English speaking LMIC participants. <h3>Conclusion</h3> Remote training provides an excellent and feasible e-learning platform to train radiotherapy professionals in LMICs. If adequately supported, the use of virtual training model can be an effective way to build capacity, as there are limited numbers of academically and clinically qualified radiation oncology professionals. These findings add to the limited knowledge of radiotherapy training developed for LMICs.

Cost Minimization Analysis of Conventional vs. Short-Course Radiotherapy with Temozolomide for Non-Elderly Patients with Newly Diagnosed Glioblastoma

<h3>Purpose/Objective(s)</h3> Standard of care for adults aged 70 years or younger with an ECOG performance status of 0-2 and newly diagnosed glioblastoma is maximal safe resection followed by radiotherapy/RT (60 Gy in 30 fractions) with concurrent temozolomide/TMZ (75mg/m2) followed by 6-12 months of adjuvant TMZ (150-200 mg/m2). Recently a phase III non-inferiority trial compared conventional (60 Gy in 30 fractions) RT with TMZ versus short-course (60 Gy in 20 fractions) RT with TMZ and found that short-course RT with TMZ was non-inferior on two separate interim analyses conducted to date. <h3>Materials/Methods</h3> We performed a cost minimization analysis to determine the cost savings of short-course RT with TMZ versus conventional RT with TMZ for patients with newly diagnosed glioblastoma. All the resources necessary to deliver the two treatment regimens including the time and expertise of various health care professionals, supplies, infrastructure, and other means were identified by experienced clinicians at our institution. Shared costs between the two different treatment regimens were identified, as they cancel each other out, and were not included in our analysis. Costs were obtained from several sources including institutional databases, collective bargaining agreements, Minister of Health cost documents, and expert elicitation. All costs were analyzed in 2022 Canadian dollars (CAD). Any cost parameters used within the model that are older than the year 2021 were inflation adjusted using the Bank of Canada inflation adjustment calculator. <h3>Results</h3> The non-shared treatment costs of one patient treated using conventional RT with TMZ versus short-course RT with TMZ was $22 532.97 and $15 021.98 respectively. Short-course RT with TMZ therefore saves $7510.89 dollars per patient treated relative to conventional RT with TMZ. For every 60 patients treated with short-course RT with TMZ, the salary of one full time radiation oncology staff position equivalent in Alberta and 600 treatment slots are recovered <h3>Conclusion</h3> For patients with newly diagnosed glioblastoma, short-course RT with TMZ leads to cost savings compared to conventional RT with TMZ. Short-course RT with TMZ also reduces the number of treatment slots needed for these patients, which has potential for improved wait times and access to RT for other cancer patients.

Home care for vulnerable populations with special needs during a disaster in Germany

Abstract Background In Europe, too, the risk of natural, technical, or man-made disasters and public health emergencies has been growing for some time. The situation of vulnerable populations with special needs receiving intensive home care such as people of all ages with oxygen therapy, peritoneal dialysis, parenteral nutrition etc. is rarely considered in this context. This issue is addressed by the sub-project “Safety and Nursing” of the AUPIK consortium on “Maintenance of home care infrastructure in crisis and disasters” funded by the German Federal Ministry of Education and Research. Methods Starting in April 2020, a systematic literature analysis was carried out, focussing on home care of populations with special needs during disasters. This was supplemented by an online survey with nurses and care workers (n = 101) and semi-structured interviews with managers of specialized home care services (n = 8). The survey data were analysed with descriptive statistics, the interview data with content analysis; results were cross-checked with the literature. Results Home care providers are at best prepared for everyday tasks; even minor disruptions have far-reaching consequences. Although the impact of disasters such as large-scale and prolonged power cuts are hard to imagine, the experience with the COVID-19 pandemic and other current events (e.g., floods, heat waves) could at least raise awareness of the problem. However, there is hardly any preparation for disasters in home care yet, but there are high expectations of support from civil protection organisations or local authorities. That these, in turn, are not prepared to deal with populations with special needs in intensive home care, is overlooked. Conclusions Home care infrastructure in Germany is currently inadequately prepared in terms of concept, staff, and equipment to care for vulnerable populations with special needs during disasters. Initiatives to improve disaster preparedness in home and long-term care are overdue. Key messages • The situation of vulnerable populations with special needs during a disaster is a pressing public health and disaster nursing issue which needs to be considered more carefully. • Public health nursing and health services research must contribute substantially to improving disaster preparedness in all health sectors and for all populations.

4.N. Workshop: Maternal Oral Health Models and Initiatives in Global and Public Health Perspectives

Abstract Achieving and maintaining good oral health is essential for both the oral and overall health of expecting mothers and the oral health of their young children. Dental caries can negatively affect daily activities, including eating, speaking, and social interaction. When expecting mothers have active dental caries, the risk for dental caries in these children becomes higher. Another common oral disease, periodontitis, was associated with systemic conditions, including cardiovascular disease, respiratory disease, diabetes, and potentially adverse birth outcomes. Some studies also showed the systemic impact of periodontal disease and the related pathogens that can lead to systemic inflammation and adverse birth outcomes, even though periodontal treatment has not been shown to improve birth outcomes. A mother's oral health status, her oral health knowledge, and beliefs also have been shown to significantly affect diet and home oral hygiene practice for young children. All the evidence suggests that pregnancy should be considered a critical period in which oral health education and dental care should be provided to improve the oral health of mothers and their young children. Despite the importance of a mother's oral health and their oral health knowledge in preventing dental caries in young children, maternal oral health is much neglected in primary and prenatal health discussions. This is even more significant in developing countries with inadequate oral health care infrastructure and workforce. In addition, with increased sugar consumption worldwide, oral disease prevention and oral health promotion are the keys to achieving oral health parity among the maternal and child population. This workshop aims to position maternal oral health as essential primary and perinatal health care and discuss the care models and initiatives in various contexts and geographical locations. At the care delivery and community-based interventions, Dr. Sophia will discuss her oral health education and tobacco cessation initiative for pregnant women in India. Dr. Irene will demonstrate her integrated oral health training model for midwives and dental providers in Indonesia. She will describe how her collaboration with the local government achieves collaborative training and care delivery to improve mothers and their spouses’ oral health and oral health knowledge in rural Indonesia. Dr. Jane will showcase her material oral health model for refugee and immigrant mothers in Switzerland. Lastly, Dr. Khabiso from South Africa will present how maternal oral health can be integrated at the national policy level through the collective efforts of public health organizations. Dr. Lee, the chair of this workshop, will provide a literature review on maternal oral health studies and how maternal oral health can be an essential part of primary and perinatal care and the WHO oral health initiative set for 2030. Key messages • Maternal oral health is essential in primary and perinatal health care discussion and a critical optic for global and public health agendas. • There are various maternal oral health programs and initiatives around the globe at care delivery level, community level, and policy level.

Introducing Maternal Oral Health As Global Health And Public Health Agenda

Abstract Background Achieving and maintaining good oral health during pregnancy is essential for both the oral and overall health of expecting mothers and their young children. Dental caries can negatively affect daily activities including eating, speaking, and social interaction, and when expecting mothers have active dental caries, the risk for dental caries in these children becomes higher. Another common oral disease, periodontitis, was found to be associated with systemic conditions, including cardiovascular disease, respiratory disease, diabetes, and potentially adverse birth outcomes. Importance Some studies also showed the systemic impact of periodontal disease and the related pathogens that can lead to systemic inflammation and adverse birth outcomes. A mother's oral health status, her oral health knowledge, and beliefs also have been shown to significantly affect diet and home oral hygiene practice among her children. Problem Despite the importance of mother's oral health and oral health knowledge to prevent dental caries in young children, maternal oral health is much neglected in primary and prenatal health discussion. This is even more significant in developing countries where oral health care infrastructure and workforce are inadequate. With increase in sugar consumption growing worldwide with this lack of oral health care infrastructure, oral diseases prevention and oral health promotion are the key to achieve oral health parity among the maternal and child population. Solution In this presentation, the author will discuss literature on maternal oral health and how to position oral health as an essential part of perinatal care along with WHO oral health initiative set for 2030. This is an introduction presentation for this workshop to set a stage and make a case why maternal oral health is a critical topic to discuss in global health and public health perspectives.

How Social Determinants of Health of Individuals Living or Working in U.S. Department of Veterans Affairs Home-Based Long-Term Care Programs in Puerto Rico Influenced Recovery after Hurricane Maria.

In September 2017, Hurricane Maria devastated Puerto Rico, causing extensive infrastructure damage and a significant number of deaths. In the months and years since, recovery from Maria has been slow, hampered by delayed delivery of fiscal aid, corruption, economic hardships, and Puerto Rico’s colonial status. Simultaneously, Puerto Rico’s population is rapidly aging and hundreds of thousands of mostly younger Puerto Ricans are migrating out of Puerto Rico for more opportunities. Many Puerto Ricans who are older or disabled and need long-term care receive this care in home-based environments, as Puerto Rico has minimal institutionalized long-term care infrastructure and limited funding to expand it. The Department of Veterans Affairs (VA) offers several home-based long-term care options for Veterans in Puerto Rico. In this qualitative case study, veterans, VA staff, veterans’ caregivers, caregivers’ family members, and veterans’ family members receiving or involved with providing this care were interviewed regarding their experiences during and after Hurricane Maria. Specifically, this study highlights how social determinants of health of those residing in or involved with VA home-based long-term care programs influenced recovery from Hurricane Maria, and how findings can inform disaster recovery and provision of home-based long-term care going forward.

Comparison of outcomes between children ventilated in a non‑paediatric intensive care and a paediatric intensive care unit: A retrospective analysis.

Lack of paediatric intensive care infrastructure, human resources and expertise in low- and middle-income countries (LMICs) often results in critically ill children being managed in non-intensive-care unit (ICU) settings. To compare the mortality between critically ill patients who required ventilation for more than 24 hours in a non-paediatric ICU (PICU) setting v. those admitted directly to a PICU. Participants were enrolled if they were between one month and 13 years of age and were ventilated in a non-PICU ward in a regional hospital and a PICU ward in a tertiary/quaternary hospital during the study period of January 2015 - December 2017 in KwaZulu-Natal, South Africa. Descriptive statistics, chi-square test, Wilcoxon test and binary logistic regression were used for data analysis. Ethics approval was obtained (approval number BE568/18 BREC) from the Biostatistics Research Council of the University of KwaZulu-Natal. Of the 904 admissions, 25.1% (n=227) were admitted to non-PICU and 74.9% (n=677) to a PICU. A significantly higher proportion of non-PICU patients were malnourished than PICU patients (26.4% v. 13.3%, p<0.001). Patients ventilated in a PICU were 76% less likely to die (p<0.001), while patients who required inotropes were 15.08 (9.68 - 24.34) times more likely to die (p<0.001). There was a statistically significant association between admission setting and survival outcome, with higher mortality in the non-PICU setting than in the PICU setting (46.3% v. 19.5%, p<0.001). Critically ill children ventilated in a non-PICU setting in KwaZulu-Natal are more likely to be malnourished, require inotropes and have higher mortality. Although increasing access to PICU bed availability is a long-term goal, the high mortality in the non-PICU setting highlights the need to optimise the availability of resources in these non-PICU wards, optimise and train the staff, and improve primary healthcare services.

P070: Design of the INSIGHT study, evaluation of long-term follow-up care for lymphoma survivors in the Netherlands: does survivorship care at the BETER clinics reduce morbidity and mortality from late effects of lymphoma treatment and associated costs?

Background: Hodgkin lymphoma (HL) survivors are at substantial risks of serious late adverse treatment effects. The BETER consortium developed a nationwide infrastructure of outpatient clinics where 5-year HL survivors are screened and treated for adverse effects of lymphoma treatment according to nationally approved screening guidelines. BETER survivorship care includes risk-based screening for and treatment of (risk factors for) cardiovascular disease (CVD), breast cancer, hypothyroidism and (functional) asplenia. So far, evidence for the actual cost-effectiveness of structured cancer survivorship care in clinical practice is lacking. Current knowledge is based on simulation and modelling approaches and evidence from other populations (e.g. BRCA mutation carriers). In the INSIGHT study we will assess the (cost-)effectiveness of BETER survivorship care using data from clinical practice. Methods: The first BETER clinics started in 2013–2016 and the number of centres participating in BETER is quickly expanding: several centres started/will start a BETER clinic in 2021–2024. This allows for a retrospective cohort study with a quasi-experimental design to evaluate the effectiveness of BETER survivorship care by comparing survivors who did and did not receive BETER survivorship care. Once full nationwide implementation is in place, this comparison is no longer possible. In the INSIGHT study we will compare 450 HL survivors invited for BETER survivorship care in 2013–2016 with 450 matched survivors invited by a BETER clinic starting in 2021–2024, allowing for a median follow-up of ~8 years. The primary outcomes are burden of disease (in disability-adjusted life-years, DALYs) from CVD, breast cancer, hypothyroidism and (functional) asplenia, associated health care costs, quality of life and health-related productivity losses. Secondary outcomes are BETER clinic attendance, guideline adherence and knowledge and risk perception of late effects. In a cost-effectiveness analysis we will calculate costs/DALY and costs/QALY of BETER survivorship care. Conclusion: BETER is an internationally unique initiative of an elaborate infrastructure for adult oncology survivorship care. To our knowledge, INSIGHT is the first evaluation of (cost-)effectiveness of cancer survivorship care in clinical practice. The results will contribute to more effective, evidence-based long-term cancer survivorship care. At ISHL12 we will present design details as well as participation rates.

Policy and Kidney Community Engagement to Advance toward Greener Kidney Care.

Policy and Kidney Community Engagement to Advance toward Greener Kidney Care.

Land back / cities back

ABSTRACT This intervention highlights that Land Back – the demand for the return of lands and waters and the transformation of social relations based on Indigenous systems of law, governance, and care - also means Cities Back. It encourages an understanding of the myriad of Indigenous reclamations of urban space in conceptually, materially, and temporally expansive ways. Land Back names diverse movements that include urban movements. In addition to struggles to reclaim land and restore jurisdiction in cities, Indigenous practices and relationalities that normalise cities as land and that centre Indigenous infrastructures of care and futurity disrupt settler-colonial urbanisms.

Infrastructures of Care for Public Housing Residents During COVID-19 Detention: Failures, Glitches and Possibilities to Care With

ABSTRACT The COVID-19 pandemic has exacerbated challenges to infrastructures of care. This study explores failures in governance, material and communication infrastructures for public housing residents during a detention order in response to a COVID-19 outbreak in Melbourne, Australia. We illustrate these failures through analysis of selected publicly available sources. Failures presented glitches in the capacity for community infrastructures of care to continue to function and emerge during the detention. Findings highlight that future pandemic planning and public housing policy needs to attentively listen to affected communities and engage with trusted community infrastructures of care, providing care that sustains our future cities.

Peripheral humanitarianism: Ephemerality, experimentation, and effects of refugee provisioning in Paris

This article examines the place-based assemblages of humanitarian care, which emerge at neighbourhood scales in response to a wider politics of exclusion. We ground our discussion in the variegated humanitarian efforts and solidarities that took place in a working-class neighbourhood on the periphery of Paris, which brought into sharp relief the combination of precarity and provisioning in the wake of the 2015 ‘refugee crisis’. Drawing on ethnographic encounters, we recount the combination of reactive, emergency humanitarian logics (between 2016 and 2017) and experimental humanitarian strategies contesting wider exclusionary and deterrence-based asylum practices (2018 to the present). We show how modes of ephemeral and experimental humanitarianism operated across local spatiotemporal nodes – inside a welcome centre (the ‘Bubble’), and on the surrounding streets. We argue that attention to the effects of the ephemeral and experimental solidarities and encounters that formed outside the formal infrastructure of humanitarian care in Paris were in part palliative, but profound in their re-imagining of a progressive politics of solidarity amidst protracted and overlapping precarities. We propose peripheral humanitarianism to describe these effects, a spatially and temporally contingent humanitarian assemblage engaging with both traditional and DIY humanitarian responses that challenges structural exclusions of racialized ‘others’.