United Kingdom Department Research Articles

A structured methodology for essential medicines lists and health emergency stockpiles: Experience with the Emergency Medicines Buffer Stock in the United Kingdom

IntroductionFormularies of essential medicines, such as Essential Medicines Lists (EMLs) and health emergency stockpiles, are intended to be always available, including in emergency situations, acting as important tools for access to medicines. The Emergency Medicines Buffer Stock (EMBS) in the United Kingdom (UK) was a stockpile of critical medicines managed by the UK Department of Health and Social Care (DHSC). We propose a new methodology for selecting and including medicines in EMLs and health emergency stockpiles and empirically apply it for selecting medicines in the case of the UK EMBS. MethodsWe used Multi-Attribute Value Theory and Portfolio Decision Analysis to develop a three-phase methodological framework for medicines selection, involving: (i) the decision context definition and selection of evaluation criteria, (ii) the therapeutic area prioritisation, and (iii) the medicines value-for-money evaluation and product selection. The EMBS application took place in 2018–2019 and focused on therapeutic area prioritisation, involving primary data collection through expert interviews (n = 4), a workshop with DHSC decision-makers (n = 13), and an online survey with National Clinical Directors and relevant experts (n = 24). A Monte Carlo simulation supported therapeutic area prioritisation using the British National Formulary (BNF) classification. FindingsTwo criteria sets were selected for i) therapeutic area prioritisation, reflecting the value concerns of population need and shortage severity, and ii) medicines evaluation, reflecting magnitude of clinical benefit and supply vulnerability, among others.Primary evidence was collected for “national need” and “shortage severity”, based on which a “population health loss” index was developed. A total of 51 therapeutic areas were ranked using their index value while assessing the robustness of the ranking. The top ranked therapeutic area was antisecretory drugs and mucosal protectants, closely followed by diabetes drugs. ConclusionsThe methodological application generated a ranking of therapeutic areas based on expected “population health loss” index, while addressing evidence uncertainty. The methodology can be adapted for other EMLs and emergency stockpile contexts to inform medicines selection.

Vaccinating Welders against Pneumococcus: Evidence from a Systematic Review and Meta-Analysis.

Workers occupationally exposed to welding dusts and fumes have been suspected to be at increased risk of invasive pneumococcal disease (IPD). Since the 2010s, the United Kingdom Department of Health and the German Ständige Impfkommission (STIKO) actively recommend welders undergo immunization with the 23-valent polysaccharide (PPV23) pneumococcal vaccine, but this recommendation has not been extensively shared by international health authorities. The present meta-analysis was therefore designed to collect available evidence on the occurrence of pneumococcal infection and IPD among welders and workers exposed to welding fumes, in order to ascertain the effective base of evidence for this recommendation. PubMed, Embase and MedRxiv databases were searched without a timeframe restriction for the occurrence of pneumococcal infections and IPD among welders and workers exposed to metal dusts, and articles meeting the inclusion criteria were included in a random-effect meta-analysis model. From 854 entries, 14 articles (1.6%) underwent quantitative analysis, including eight retrospective studies (publication range: 1980-2010), and six reports of professional clusters in shipbuilding (range: 2017-2020). Welders had an increased likelihood of developing IPD compared with non-welders (odds ratio 2.59, 95% CI 2.00-3.35, I2 = 0%, p = 0.58), and an increased likelihood of dying from IPD (standardized mortality ratio (SMR) 2.42, 95% CI 1.96-2.99, I2 = 0%, p = 0.58). Serotype typing was available for 72 cases, 60.3% of which were represented by serotype 4, followed by 12F (19.2%) and serotype 8 (8.2%). Although the available data derive from a limited number of studies, available results suggest that pneumococcal vaccination should be recommended for workers exposed to welding fumes, and vaccination strategies should consider the delivery of recombinant formulates in order to combine the direct protection against serotypes of occupational interest with the mucosal immunization, reducing the circulation of the pathogen in occupational settings characterized by close interpersonal contact.

Rethinking ‘Knowledge in Use’ in Small Businesses: A Perspective

Small businesses are the backbone to every economy and according to the United Kingdom (UK) Department for Business, Innovation and Skills, accounts for about 48% (12.9 million) of employment and about 36% (1.6 trillion) in business turnover, job creation and local communities. In a period where the Covid-19 pandemic and war in Ukraine has damaged economic activities, small businesses are under pressure with breakdown in supply chains and inflationary situations leading to loss in sales and closures. Though many governments, including the UK government have devised special measures to support small businesses, this has not been not had the required effects across the board as failures increase and the perception of success is low, for example the UK Department of Business, innovation and Skills (2018) reports that there was a decrease of small business in the UK of 1.5% (about 82,000 businesses) between 2021 and 2022 and 6.5% between 2020 and 2021. This article takes the view that small businesses could look more inwardly and rethink their ‘knowledge in use’ as a critical success resource to adapt and survive in a chaotic environment. It also provides suggestions for small business owners and policymakers. Understanding this would require knowledge of self and the fundamental reasons for being in business, that of being an entrepreneur and therefore being entrepreneurial. Small businesses as compared to bigger businesses revolve around their owner-managers who are entrepreneurs.

A cross-sectional study to assess the clinical utility of modern visual function assessments in patients with inherited retinal disease: a mixed methods observational study protocol

BackgroundTreatment options for patients with inherited retinal disease are limited, although research into novel therapies is underway. To ensure the success of future clinical trials, appropriate visual function outcome measures that can assess changes resulting from therapeutic interventions are urgently required. Rod-cone degenerations are the most common type of inherited retinal disease. Visual acuity is a standard measure but is typically preserved until late disease stages, frequently making it an unsuitable visual function marker. Alternative measures are required. This study investigates the clinical utility of a range of carefully selected visual function tests and patient reported outcome measures. The aim is to identify suitable outcome measures for future clinical trials that could be considered for regulatory approval.MethodsThis cross-sectional study involves two participant groups, patients with inherited retinal disease (n = 40) and healthy controls (n = 40). The study has been designed to be flexible and run alongside NHS clinics. The study is split into two parts. Part one includes examining standard visual acuity, low luminance visual acuity, the Moorfields acuity chart visual acuity, mesopic microperimetry and three separate patient reported outcome measures. Part two involves 20 min of dark adaptation followed by two-colour scotopic microperimetry. Repeat testing will be undertaken where possible to enable repeatability analyses. A subset of patients with inherited retinal disease will be invited to participate in a semi-structured interview to gain awareness of participants’ thoughts and feelings around the study and different study tests.DiscussionThe study highlights a need for reliable and sensitive validated visual function measures that can be used in future clinical trials. This work will build on work from other studies and be used to inform an outcome measure framework for rod-cone degenerations. The study is in keeping with the United Kingdom Department of Health and Social Care research initiatives and strategies for increasing research opportunities for NHS patients as part of their NHS care.Trial registrationISRCTN registry, ISRCTN24016133, Visual Function in Retinal Degeneration, registered on 18th August 2022.

Impact of Ground Cover Dataset Selection on CNOSSOS-EU Calculated Levels

The United Kingdom Department for Food and Rural Affairs (Defra) commissioned a series of studies investigating the sensitivity of the CNOSSOS-EU noise assessment method. CNOSSOS-EU presents challenges in terms of input data accuracy and availability. For this reason, the studies were commissioned to support data decision making and quantify potential uncertainty in Defra's national noise model. A study was undertaken to identify how the selection of a ground cover dataset may influence calculated noise levels using the CNOSSOS-EU noise assessment method and computational load. Acoustic test models were developed incorporating prepared ground cover datasets based on CORINE Land Cover 2018, CEH Land Cover Map 2019 and OS Mastermap Topography. Noise calculations in accordance with CNOSSOS-EU were carried out for rural and urban/suburban propagation environments. A statistical analysis of the differences between each selected dataset was then undertaken. The paper discusses the findings of this analysis along with generic rules which were identified with respect to modelling ground effect using CNOSSOS-EU.

Determining and quantifying effects of Favourable Propagation on CNOSSOS-EU Calculated Noise Levels

The United Kingdom Department for Food and Rural Affairs (Defra) commissioned a series of studies investigating the sensitivity of the CNOSSOS-EU noise assessment method. CNOSSOS-EU presents challenges in terms of input data accuracy and availability. For this reason, the studies were commissioned to support data decision making and quantify potential uncertainty in Defra's national noise model. A study was undertaken to identify approaches to quantifying the effect of favourable propagation (FP) when calculating noise levels using the CNOSSOS-EU noise assessment methodology. Literature reviews allowed the identification of two methodologies for quantifying the occurrence of FP, and their respective data requirements. Data requirements were reviewed against data available from meteorology stations across UK and a method selected. FP was calculated for met sites in England and presented in tables and in the form of meteorological roses. Analysis was then undertaken exploring the effect of including of FP on sound propagation using CNOSSOS-EU using a test model. Comparisons were then made against assuming 100% favourable and 100% homogeneous conditions to identify the importance of calculating the occurrence of FP in noise exposure data.

Sensitivity of Input Parameter on CNOSSOS-EU Road Emission Levels

The United Kingdom Department for Food and Rural Affairs (Defra) commissioned a series of studies investigating the sensitivity of the CNOSSOS-EU noise assessment method. CNOSSOS-EU presents challenges in terms of input data accuracy and availability. For this reason, the studies were commissioned to support data decision making and quantify potential uncertainty in Defra's national noise model. The quality framework set out in Directive 996/2014 requires uncertainty in road emission levels at source to correspond to an uncertainty of ±2dB(A). By calculating emissions across a range of values for input parameter within various scenarios in which all other parameters were kept constant, changes in road traffic noise emissions were observed. This was performed separately for each of the five CNOSSOS-EU vehicle categories as well as for a selection of hypothetical composite road traffic flows. A similar analysis was then performed for a series of road surface types. The results were used to indicate which input parameters road traffic noise emissions were most sensitive to. The results identified that uncertainty in traffic flow speed has a tolerance of ±11 kmh-1 for cars and two-wheelers, and ±24 kmh-1 for HGVs in order to meet the quality framework. Significant variation in emissions were found across surface types, indicating the importance of obtaining representative road surface data. The study found that traffic volumes should be within 60% of their true value. The effect of road gradient was found to be dependent on flow composition and speed. Road traffic noise emissions were found to be insensitive to changes in air temperature. Composite flow analysis using English traffic statistics with various proportions of HGVs showed that these assumptions become more important on lower speed roads, while the proportion of two-wheelers is relatively insignificant with respect to overall noise emissions.

Automation of a National Noise Model

The United Kingdom Department for Food and Rural Affairs (Defra) commissioned the design and build of an environmental noise modelling system (NMS). The NMS has been developed to support Defra in developing its environmental noise evidence base by preparing national road and railway noise models. This paper discusses the automation aspects of the NMS with respect to the various elements required for a noise model. This includes the development of sophisticated data processing engines and the techniques utilised to automate the delivery of a 3-dimensional noise propagation environment, and road and railway noise emissions. It highlights several innovative methods which are now possible due to the data landscape in England and how through open data standards the NMS has the potential to improve the fidelity of national noise models.

Sensitivity of Input Parameter on CNOSSOS-EU Railway Emission Levels

The United Kingdom Department for Food and Rural Affairs (Defra) commissioned a series of studies investigating the sensitivity of the CNOSSOS-EU noise assessment method. CNOSSOS-EU presents challenges in terms of input data accuracy and availability. For this reason, the studies were commissioned to support data decision making and quantify potential uncertainty in Defra's national noise model. The quality framework set out in Directive 996/2014 requires uncertainty in rail emission levels at source to correspond to an uncertainty of ±2dB(A). Due to the CNOSSOS-EU rail emission model being of multivariate complexity, and the multitude of possible parameter combinations, a scenario and parametric-based approach was taken to the study. The variation in rail emission levels was presented for each parameter for a set of rail vehicle speeds and rail infrastructure scenarios. The results of the analysis indicated which input parameters the CNOSSOS-EU rail noise emission model is most sensitive to. It was found that emissions are most sensitive to changes in the number of axles on the vehicle (i.e. wheel / rail interaction), the density of track joints (impact noise), the curvature of the track (squeal noise), and the construction of bridges (structural resonances). However, the choice of rail roughness, vehicle transfer function, and track transfer function (except in the case of direct fastenings) were found to have a limited impact on rail emission levels.

The effects of night-time aviation noise exposure on sleep disturbance and annoyance

This paper will report on the methodology for a new UK study of aviation night-noise exposure on health. Funded by the United Kingdom Department of Transport (DfT), the study is examining the effects of aviation night-noise exposure for a range of night-time periods on sleep disturbance and annoyance. The study involves a cross-sectional survey of 4000 participants living near eight UK airports to assess associations of aircraft noise exposure at night and subjective sleep disturbance and annoyance, as well as an objective sleep disturbance study of 170 participants, where physiological assessments of sleep disturbance will be linked to aircraft noise exposure at the participant’s home. The study will deliver exposure-response functions showing how time-averaged metrics such as LAeq,8h, LAeq,1h, N60 relate to subjective and objective sleep disturbance, and annoyance, which could be used to inform updates to the DfT’s Transport Analysis Guidance (TAG) and subsequently aviation night-noise policy in the UK. It will also explore if a relationship for objective sleep disturbance can be estimated for event-related metrics such as LAmax and sound exposure level. Effect modification will be examined; quantifying whether some population groups may be more vulnerable to the effects of aviation night-noise on sleep disturbance and annoyance.

Coloniality and othering in DFID’s development partnership with South Africa

ABSTRACT Development aid discourses have been criticised for perpetuating othering and coloniality. They have been argued to produce and reproduce conceptual creations of a distinguishable ‘us’ and ‘them’ and uphold hierarchies where former colonial powers remain preeminent and subjugate the ‘Global South’. The turn of the century, however, saw the emergence of ‘development partnerships’ to rebalance asymmetrical relationships between donor and recipient. Developing a critical discourse analysis framework from decolonial scholarship and applying it to the United Kingdom Department for International Development’s development partnership with South Africa between 2014 and 2018, the article reveals clear examples of othering and coloniality. The suggestion of mutuality therefore appears to be just a façade, and the development partnership discourse is rather emphasising difference and justifying colonial hierarchies, contradicting its purported values. Recommendations include increased scrutiny of dehistoricised and decontextualised development narratives, and clearly stating national and political interests in bilateral partnerships.

The carbon footprint of government health department fleet vehicles in Johannesburg, South Africa – a case study

ABSTRACT The Intergovernmental Panel on Climate Change (IPCC) has concluded that climate change is caused by human activities. This case study presents findings on the vehicle use by the Department of Health in Ekurhuleni, Gauteng province, South Africa. The objectives of this study are to estimate the carbon dioxide equivalent emissions of government fleet vehicles and to identify mitigation measures to reduce the vehicle carbon emissions. Both the World Resource Institute Greenhouse Gas Protocol (GHGP) and the United Kingdom Department of Environmental Forestry and Rural Affairs (DEFRA) methodologies were used. The study revealed that the government fleet vehicles emitted 1362 t CO2e for a five year period (2010 − 2014), which is equivalent to $ 9 071 of the South African carbon tax. Various measures to reduce CO2e emissions were recommended, money saving from fuel and potential revenue generating opportunities were identified, including the use of hybrid vehicles.

Climate Change Mitigation by Quantification of Greenhouse Gas Emissions from Office Operations of a Global Logistics Company

Climate change is a global phenomenon that affects all continents. Climate change has become the most discussed topic in the last decade, owing to the increasing probability of extreme events occurring. Mitigation of climate change focuses on avoiding and reducing greenhouse gas emissions into the atmosphere. The industrial sector significantly contributes to anthropogenic greenhouse gas (GHG) emissions, which are one of the primary causes of climate change. Calculating a company’s carbon footprint (CF) is an important step toward reducing quantifiable emissions because it indicates the contribution of each activity to GHG emissions. The objectives of this study were to identify the major contributors to organizational GHG emissions and provide possible solutions for emission reduction. This research examines the organizational CF of a logistics company for a year, from April 2020 to March 2021. That global company, which has more than 2,900 employees in 32 countries and provides freighting, warehousing, and other solutions to the community, contributes to GHG emissions through freight transport and office operations. Office operations were considered here, and operational boundaries were established within offices in fourteen countries. GHG Protocol was chosen as the methodology for quantifying the organization’s CF. GHG emitting activities were identified and classified into three categories under the GHG protocol. Secondary data was collected from the company database called Sustainable Management System for the calculation, and invoices and bills were checked to ensure data accuracy. To extract emission factors, publications from the United Kingdom's Department for Environment, Food and Rural Affairs (DEFRA), the Sri Lanka Sustainable Energy Authority website, the Institute of Global Environmental Strategies (IGES) list of grid emission factors, and the World Bank Open Database were consulted. The annual carbon footprint was 3,710 tCO2e. The highest emission value resulted from indirect emissions associated with purchased electricity, which is 2,180 tCO2e and accounts for 58.8% of the company’s annual carbon footprint. The proportions of direct and other indirect emissions were reported to be 14.4%and 26.8%, respectively. Per capita consumption for the company was 2.18 tCO2e. The highest per capita consumption was reported from the stations in Sri Lanka which was 4.57 tCO2e. To reduce greenhouse gas emissions, measures such as implementing solar energy systems and setting emission reduction targets are proposed as the major suggestions. This study is a part of the initiatives undertaken by the company to reduce its GHG emissions.
 Keywords: Carbon footprint, Climate change, Mitigation, GHG emissions

New Working Practices: A Scientometric Review

Study on New Working Practices (NWPs), which is the subject of this review paper, has created a large body of literature. Studies in this research area are progressing quickly, and it is important to stay abreast of new trends and essential factors in the growth of mutual awareness. This study evaluates the global scientific output of New Working Practices (NWPs) research and explores their hotspots and frontiers from 1980 to 2018 (pre-COVID-19), using bibliometric methods. 850 relevant articles were retrieved from the Web of Science Core Collection (WoSCC) and analysed. Scientometric method and Citespace VI were used to analyse the bibliometric data. Reference citation and cocitation networks were plotted, while keywords were used to analyse the research hotspots and trends. There is a significant increase in the number of annual publications with time. The United Kingdom (UK) ranked highest in the countries with most publications, and the leading author is Friedhelm Nachreiner based on publication counts. The most cited author/organisation is the UK Department of Health. Performance, work, and flexible working are the research hotspots, while flexible working arrangement represents the prominent research domain. The study offers valuable references for researchers, industry practitioners and policymakers.

Reconstructing the Symptomatic-Case Epidemic from COVID-19-Related Deaths in England: A Spatiotemporal Modelling Study

Background: The COVID-19 epidemic has differentially impacted communities across England, with regional variation in rates of confirmed cases, hospitalisations and deaths. Measurement of this burden changed substantially over the first months, as surveillance was expanded to accommodate the escalating epidemic. Laboratory confirmation was initially restricted to clinical need (“pillar 1”) before expanding to community-wide symptomatics (“pillar 2”). This study aimed to ascertain whether biases in case data resulting from varying testing coverage could be addressed by drawing inference from COVID-19-related deaths. Methods: We fit a Bayesian spatio-temporal model to weekly COVID-19-related deaths per local authority (LTLA) throughout the first wave (1 January - 30 June 2020), with respect to the local epidemic timing and the age, deprivation and ethnic composition of its population. We drew predictions averaging these sources of case-fatality variation, and back-translated according to a population case fatality ratio estimated under community-wide testing. Results: A model including temporally- and spatially-correlated random effects best accommodated the observed variation in mortality, after accounting for local population characteristics. Final predictions suggest a total of 276,219-420,491 cases over the first wave - an increase of 19-81% from the reported. Conclusions: Limitations in testing capacity biased the observed trajectory of COVID-19 cases throughout the first wave. Basing inference on COVID-19-related mortality and higher-coverage testing later in the time period, we could explore the extent of this bias more explicitly. Evidence points towards substantial under-representation of initial growth and peak magnitude of symptomatic infections nationally, to which different parts of the country contribute unequally.Funding Information: The following funding sources are acknowledged as providing funding for the named authors:This research was partly funded by the Bill & Melinda Gates Foundation (NTD Modelling Consortium OPP1184344: GFM; OPP1183986: ESN). Royal Society (Dorothy Hodgkin Fellowship: RL). Wellcome Trust (206250/Z/17/Z: TWR; 206471/Z/17/Z: OJB; 210758/Z/18/Z: SA). The following funding sources are acknowledged as providing funding for the working groupauthors:This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: MQ; INV-003174: JYL, KP, MJ, YL; INV-016832: SRP; NTD Modelling Consortium OPP1184344: CABP; OPP1139859: BJQ; OPP1191821: KO'R). BMGF (INV-016832; OPP1157270: KA). CADDE MR/S0195/1 & FAPESP 18/14389-0 (PM). EDCTP2 (RIA2020EF-2983-CSIGN: HPG). Elrha R2HC/UK FCDO/Wellcome Trust/This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (KvZ). ERC Starting Grant (#757699: MQ). ERC (SG 757688: CJVA, KEA). This project has received funding from the European Union's Horizon 2020 research and innovation programme - project EpiPose (101003688: AG, KP, MJ, RCB, WJE, YL). FCDO/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP, KvZ). This research was partly funded by the Global Challenges Research Fund (GCRF) project 'RECAP' managed through RCUK and ESRC (ES/P010873/1: CIJ, TJ). HDR UK (MR/S003975/1: RME). HPRU (NIHR200908: NIB). Innovation Fund (01VSF18015: FK). MRC (MR/N013638/1: EF, NRW; MR/V027956/1: WW). Nakajima Foundation (AE). NIHR (16/136/46: BJQ; 16/137/109: BJQ, FYS, MJ, YL; 1R01AI141534-01A1: DH; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: TJ; NIHR200908: AJK, RME; NIHR200929: CVM, FGS, MJ, NGD; PR-OD-1017-20002: AR, WJE). Singapore Ministry of Health (RP). UK DHSC/UK Aid/NIHR (PR-OD-1017-20001: HPG). UK MRC (MC_PC_19065 - Covid 19: Understanding the dynamics and drivers of the COVID-19 epidemic using real-time outbreak analytics: NGD, RME, SC, TJ, WJE, YL; MR/P014658/1: GMK). Authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). UKRI Research England (NGD). UKRI (MR/V028456/1: YJ). Wellcome Trust (206250/Z/17/Z: AJK; 208812/Z/17/Z: SC, SFlasche; 210758/Z/18/Z: JDM, JH, SFunk, SRM; 221303/Z/20/Z: MK; UNS110424: FK). No funding (AMF, DCT, YWDC).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: Approval for the use of anonymised linelist data was granted by Public Health England and the Department for Health and Social Care. Consent of individuals was not required as no patient identifiable information was used.

Challenging behaviour around challenging behaviour.

The United Kingdom's Department for Education's advice on behaviour focuses on the power of staff and the strength of the policy in challenging behaviour, via rules, sanctions and rewards. We designed a video-feedback intervention for staff teams in a special educational setting who were working with children with intellectual disability and challenging behaviour. The intervention aimed to raise reflective capacity on relational mechanisms that offer new response possibilities in everyday practices within trans-disciplinary teams. We conducted research with three teams (between five and seven participants in each). We report findings from two teams who were working with children (aged between 10 and 14) who staff identified as having behaviour that challenged. The intervention consisted of two video-feedback intervention sessions, using clips of good interactions between themselves and the child and a review. These sessions took place over three or four months. Qualitative analysis was conducted to analyse changes to the language and depictions of the children. Changes to the participants' goals during the intervention were also analysed. The staff's focus on the child's challenging behaviour reduced. Children who were originally depicted as isolated became depicted in relationship with peers and staff. Participants became more curious about the child and his interactions in the school and home environment. The participant's personal goals emerged through their understandings of what it meant to be good. Working with staff teams using video feedback can change the interactions around the child and the relational conceptualisation of the child and family. Further adaptations to the intervention are needed to raise critical reflection on the concepts that circulate around 'behaviour' that structure policy and shape everyday practices.

Fighting corruption in Nigeria: excessive rhetoric and indeterminate bureaucratic practices in the implementation of SERVICOM

ABSTRACT This paper explores the SERVICOM reform, which was instituted in 2004 to fight the corruption and inefficiency considered to plague the Nigerian Civil Service. Using the method of ‘following the policy’, the paper demonstrates the meaning of SERVICOM for its various stakeholders: United Kingdom Department for International Development (DFID) officers, Nigerian bureaucrats, SERVICOM officers and citizens. The paper also shows how SERVICOM is made in the indeterminate bodily movements and social interactions of street-level bureaucrats rather than in the policy models crafted by experts. Not only has SERVICOM been incoherently implemented, it has also has been characterised by excessive rhetoric, which has constructed the idea of a good-willed technocratic state, eliciting ambivalence and catharsis in public discourse. Further, DFID officers have construed the reform as a success. This research provides an ethnographic perspective on how transnational ‘good governance’ initiatives in Africa are translated on the ground.

Towards a national capability framework for Artificial Intelligence and Digital Medicine tools – A learning needs approach

Artificial Intelligence has the potential to transform the delivery of healthcare in the National Health Service (NHS), from streamlining workflow processes to improving accuracy of diagnosis and personalising treatment, as well as helping staff to work more efficiently and effectively. Digital technologies have transformed most sectors which affect our daily lives, from communication to transport, banking and entertainment, and healthcare is now starting to follow. These technologies will allow patients and clinicians to better manage and monitor chronic health conditions, promote health and wellbeing and deliver care with more innovative approaches. For successful implementation and adoption of these technologies within the health system, there is an apparent focus towards preparing, upskilling and supporting the current and future healthcare workforce through traditional educational approaches. Health Education England, an executive non-departmental public body, sponsored by the United Kingdom's Department of Health and Social Care, is taking steps to perform a learning needs analysis to inform the first national capability framework for Artificial Intelligence and Digital Medicine tools, to direct educational strategy and policy which will have local, national and international implications for healthcare education.

Commute Patterns, Residential Traffic-Related Air Pollution, and Lung Cancer Risk in the Prospective UK Biobank Cohort Study

Background:: Commuting exposes millions of people to lung carcinogens from traffic-related air pollution (TRAP). In the United Kingdom (UK) Biobank cohort study, we investigated associations between commute patterns, residential nitrogen dioxide concentrations (NO2; a surrogate for TRAP), and lung cancer risk. Methods: We analyzed 234,124 employed participants at baseline (2006-2010). Subjects were cross-classified into exclusive categories of commute mode (automobile, public transportation, walking, cycling, active mixture, and other mixture) and frequency (regular:1-4, often:≥5 work-bound trips/week). Annual average residential NO2 concentrations in were estimated with land use regression. Multivariable Cox regression was used to estimate associations between commute patterns, NO2 quartiles, and lung cancer. Findings: There were 493 incident lung cancer cases diagnosed over an average 7-year follow-up. Compared to regular automobile use, commuting often by public transportation was associated with increased lung cancer risk (hazard ratio (HR)=1·58, 95% confidence intervals (CI):1·08-2·33). Additionally, we found a positive exposure-response relationship with residential NO2 (HR Q2 =1·21, 95%CI:0·90-1·62; HR Q3 =1·48, 95%CI:1·10-1·99; HR Q4 =1·58, 95%CI:1·13-2·23; p-trend=3·1x10-3 ). The public transportation association was observed among those with higher NO2 (p-interaction=0·02). Other commute categories were not significantly associated with risk. Interpretation: Commuters residing in high-NO2 areas who often use public transportation could have elevated lung cancer risk, possibly from traversing high-TRAP microenvironments. These preliminary results require replication and refinement to determine which, if any, component of public transportation is associated with lung cancer. Funding: Intramural support from the National Cancer Institute and funding from Wellcome Trust, Medical Research Council, UK Department of Health, Scottish Government, Welsh Assembly Government, British Heart Foundation, and Diabetes United Kingdom. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The UK Biobank study was approved by the National Information Governance Board for Health and Social Care and the NHS North West Multicenter Research Ethics Committee.

Examining the Immunological Effects of COVID-19 Vaccination in Patients with Conditions Potentially Leading to Diminished Immune Response Capacity – The OCTAVE Trial

SARS-COV-2 vaccines have been shown to be efficacious primarily in healthy volunteer populations and population level studies. Immune responses following SARS-CoV-2 vaccination are less well characterised in potentially immune vulnerable patient groups, including those with immune-mediated inflammatory and chronic diseases (inflammatory arthritis [IA] incorporating rheumatoid arthritis [RA] and psoriatic arthritis [PsA]; ANCA-Associated Vasculitis [AAV]; inflammatory bowel disease [IBD]); hepatic disease (HepD), end stage kidney disease requiring haemodialysis (HD) without or with immunosuppression (HDIS); solid cancers (SC) and haematological malignancies (HM), and those that have undergone haemopoietic stem cell transplant (HSCT). The OCTAVE trial is a multi-centre, multi-disease, prospective cohort that will comprehensively assess SARS-CoV-2 vaccine responses within and between the abovementioned disease cohorts using common analytical platforms in patients recruited across the United Kingdom (UK). The majority of subjects received either COVID-19 mRNA Vaccine BNT162b2 (Pfizer/BioNTech) or ChAdOx1 Vaccine (AstraZeneca formerly AZD1222) as part of the UK National COVID19 vaccination programme. As of 13 th August 2021; 2,583 patients have been recruited. We report herein the humoral and T cell immune response results from the first 600 participants recruited where serology data are available at baseline, pre-second vaccine dose (boost) and/or 4 weeks post second dose. We also include in the analysis, data obtained from 231 healthy individuals from the PITCH (Protective Immunity from T cells in Healthcare workers) study. Overall, in comparison to PITCH where 100% of tested individuals (n=93) generated anti-Spike antibodies after vaccine doses, 89% of patients within OCTAVE seroconverted 4 weeks after second vaccine dose. By corollary, approximately 11% of patients across all disease cohorts fail to generate antibodies that react to SARS-CoV-2 spike 4 weeks after two vaccines. Failure to generate spike reactive antibodies was found at a higher proportion in some specific patient subgroups, particularly AAV (72.4%), HD-IS (16.7%) and HepD (16.7%). Importantly, all recruited AAV patients had received Rituximab; a targeted B cell depletion therapy. Furthermore, even in those who seroconverted, 40% of patients across disease cohorts generate lower levels of SARS-CoV-2 antibody reactivity compared to healthy subjects after two SARS-CoV-2 vaccines; the functional significance of these findings in providing protection from subsequent SARS-CoV-2 exposure is not currently known. In contrast to the observed serological response, evaluation of the Spike-specific T cell response revealed that across all patient sub-groups (including AAV) a response similar to healthy individuals was generated. Our data argue strongly for further vaccination strategies to optimise humoral immune responses against SARS-CoV-2 in patients with chronic diseases and/or patients on immune suppressive therapies. Trial Registration: The trial is registered on ISRCTN 12821688.Funding: This work was supported by the Medical Research Council COVID-19 Immunity – National Core Study (IMM-NCS) [grant number MC-PC-20031]. Staff at the Cancer Research UK Clinical Trials Unit (CRCTU) are supported by a core funding grant from Cancer Research UK (C22436/A25354). PK and EB are supported by the NIHR Birmingham Biomedical Research Centres at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham Biomedical Research Centres. EB and PK are supported by an NIHR Senior Investigator award. PK is funded by WT109965MA. SJD is funded by an NIHR Global Research Professorship (NIHR300791). TdS is funded by a Wellcome Trust Intermediate Clinical Fellowship (110058/Z/15/Z). DS is supported by the NIHR Academic Clinical Lecturer programme in Oxford. LT is supported by the Wellcome Trust (grant number 205228/Z/16/Z), the U.S. Food and Drug Administration Medical Countermeasures Initiative contract 75F40120C00085. and the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections (NIHR200907) at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine and the University of Oxford. The PITCH (Protective Immunity from T cells to Covid-19 in Health workers) Consortium, is funded by the UK Department of Health and Social Care with contributions from UKRI/NIHR through the UK Coronavirus Immunology Consortium (UKCIC), the Huo Family Foundation and The National Institute for Health Research (UKRIDHSC COVID-19 Rapid Response Rolling Call, Grant Reference Number COV19-RECPLAS).Declaration of Interest: None to declare. Ethical Approval: This study was approved by the UK Medicines and Healthcare Products Regulatory Agency on the 5th February 2021 and the London and Chelsea Research Ethics Committee (REC Ref:21/HRA/0489) on 12th February 2021, with subsequent amendments approved on 3rd March 2021, 19th April 2021 and 26th April 2021).