Search

Securing equitable antibiotic access as an essential component for health system resilience and pandemic preparedness requires a systems perspective. This article discusses key components that need to be coordinated and paired with adequate financing and resources to ensure antibiotic effectiveness as a global public good, which should be central while discussing a new global agreement.

Controlled Digital Lending (CDL) became a popular term in the United States of America (USA) libraries as a result of a white paper authored by Kyle K. Courtney (Harvard University) and David Hansen (Duke University). (Citation?) The white paper gave the legal groundwork to explore the copyright aspect of CDL: Fair Use, First Sale Doctrine and Supreme Court rulings. The white paper also provided guidelines for Library professionals implementing this new technology to fulfill their users’ needs. Inspired by the recent CDL guidelines developed by Courtney and Hansen (2018) two librarians from the University of Florida (UF), and Florida Gulf Coast University (FGCU) started a conversation about how to develop strategies to make CDL work possible at each institution. The authors share their stories of piloting and initiating a CDL program to ensure students have reliable, affordable access to course materials they need to be successful. Additionally, the authors discuss the emerging trends of CDL in the USA, and the development of the CDL platforms, policies and implementation plans. Most importantly, the implementation of these programs presents challenges, lessons learned, and plans to sustain the program in the future.

(1) Background: This article examines whether connection to digital technologies helps connect young Indigenous people in Australia to culture, community and country to support good mental health and well-being and protect against indirect and potentially long-term effects of COVID-19. (2) Method: We reviewed literature published between February and November 2020 and policy responses related to digital strategies. We searched PubMed, Google Scholar, government policy websites and key Indigenous literature sources, identifying 3460 articles. Of these, 30 articles and 26 policy documents were included and analysed to identify existing and expected mental health outcomes among Indigenous young people associated with COVID-19 and more broadly. (3) Results: There are inequities in affordable access to digital technologies. Only 63% of Indigenous people have access to internet at home. Digital technologies and social media contribute to strong cultural identity, enhance connections to community and country and improve mental health and social and emotional well-being outcomes. (4) Discussion: Access to digital technologies can facilitate healing and cultural continuity, self-determination and empowerment for young people to thrive, not just survive, in the future. (5) Conclusion: More targeted policies and funding is urgently needed to promote digital technologies to enhance Indigenous young people's access to mental health and well-being services, maintain cultural connections and evaluate the effectiveness of these initiatives using Indigenous well-being indicators.

Dear editor,Given time, drug discovery programmes will undoubtedly yield highly potent drugs to form the basis of optimised COVID-19 regimens. However, if efficacious therapies can be identified from current medicines, repurposing represents the fastest route to establish deployable interventions and buy time for vaccine and novel drug development. It is important to note that effective medicines were rigorously optimised for the treatment of specific indications. Route of administration, dosage and schedules for existing therapies were optimised to provide adequate plasma/tissue pharmacokinetics and safety for their target disease or condition. These cannot be assumed to be optimal for COVID-19 but are often highly predictable from pre-existing data and clinical experience. For example, hydroxychloroquine and lopinavir/ritonavir recently failed to deliver benefits in RCTs for mild/moderate and severe disease,1, 2 but the clear disconnect between reportedin vitro antiviral activity and known human pharmacokinetics after administration of approved doses was predictable.3Interpretation of laboratory-based antiviral activity assessments is complicated by current uncertainty regarding the appropriateness of the existing model systems. The majority of in vitro antiviral screening assays have utilised Vero cells, which were derived from the kidney of African Green Monkey in the 1970s, and the lack of clinical evidence for which to validate the exposure-response relationship in humans is problematic. Evidence is emerging that the anti-SARS-CoV-2 activity of drugs may be higher in cells derived from humans. However, the question of which cell types are most representative of in vivo performance is yet to be addressed, and all that can really be concluded from current knowledge is that the susceptibility of SARS-CoV-2 to antivirals is cell-type-dependent. The consequences of this in terms of the variety of cell types known to be infected and/or sustain productive infection in vivo is equally uncertain, and further exacerbated by the lack of robustly validated animal models. However, repurposed drugs cannot be assumed to be active against SARS-CoV-2 at a dose that was optimised on the basis of potency for and accumulation at their initial therapeutic target.Nucleoside/nucleotide polymerase inhibitors have proven highly successful for other viruses, but usually require combination with another drug class. Remdesivir and favipiravir have in vitro anti-SARS-CoV-2 activity across multiple studies, and the unprecedented speed at which they have transitioned through COVID-19 RCTs can only be commended.4, 5, 6 Daily IV infusion may make inherent sense for severely ill patients, but a transformational impact for COVID-19 can only be realised if wide compatibility with global healthcare systems and equitable access across all country contexts is achieved. While reduction in symptom duration may mitigate healthcare saturation in high-income countries, the absence of a clear benefit for mortality diminishes game-changing potential. However, the clinical validation of the antiviral activity of such drugs will make them clear candidates for implementation as part of community-based interventions if other challenges are addressed. Importantly, the combination of nucleoside analogues with a secondary target such as the protease has stood the test of time in antiviral pharmacology. The recent reports of low-dose dexamethasone leading to an impact on mortality7 is a significant step forward but long-term mitigation of viral transmission, with subsequent economic and social restrictions, requires antiviral treatment or prevention to minimise hospitalisation through a community-targeted approach.Focussing on existing single drugs, and not appropriately formulated medicines, will require the rethinking of a number of medicine development parameters such as posology, reformulation and therapeutic index (Figure 1); current HIV medicines, for example, are formulated for chronic (life-long) dosing to moderate and control disease but a successful COVID-19 therapy will likely require only a short term acute administration to rapidly cure the patient. Conversely, different considerations are required for longer-term applications in COVID-19 chemoprophylaxis, which could have a dramatic effect on control of the pandemic.Many advanced drug delivery technologies have emerged in recent years. Long-acting drug delivery involving injectable, implantable or microarray patch mediated delivery have attracted enormous recent interest for prevention of other infectious diseases,8, 9 and the ability to deliver potent antiviral combinations for a period of months could play a transformational role in the absence of a safe and efficacious vaccine. The physicochemistry and activity of the polymerase inhibitors, and other drugs with known anti SARS-Cov-2 activity, also warrants investigation of pulmonary delivery via nebuliser or metered dose inhaler for direct dosing to the upper airways to supplement systemic drug delivery as pre- or post-exposure prophylaxis. Several advanced drug delivery strategies can be applied rapidly and do not need to be prohibitively expensive for global community programmes. It seems unlikely that a global pandemic can be ended if effective medicines are only available to the few and equitable access is therefore of benefit to all. Importantly, relying solely upon pre-existing formulations and posologies optimised for other diseases carries inherent risk of rejecting drug candidates with an otherwise high potential for global impact.

Access to tertiary education in the least developed countries, such as Lesotho, continues to be a rare experience for persons with disabilities who, despite being admitted to studies, struggle with meaningful participation. This article explores student experience of persons with disabilities studying at the National University of Lesotho. A combination of convenience and snowballing sampling techniques were used to recruit 15 staff members and 11 students enrolled in various programmes. A combination of individual semi-structured interviews and a focus group discussion were used to generate data. Findings reveal that various dimensions of student experiences are negatively affected. Students with disabilities encounter mobility challenges due to an inaccessible built environment; lecture timetables are not adapted to suit the needs of students with mobility challenges, blind students are not informed of potholes that are left uncovered and the students’ request for their hostel to be adapted is not addressed. Additionally, students are not readily supported by their lecturers while some are subjected to bullying which goes unpunished and the victims receive no counselling for the resultant trauma. These factors affect the students’ welfare and have an effect on their academic participation. The students are simply expected to conform to university practices. The summary of student experience, if used for assessment of quality education, demonstrates inequitable access to education for persons with disabilities. The study concludes that the institution provides poor-quality education as it fails to address the support needs of students with disabilities. The study recommends development of policies and practices that promote equity, and that student experience can be used to inform how the institution may improve access and the quality of its programmes. Equally, this study challenges students with disabilities to assert their right to an inclusive and equitable quality education.

This study examined the influence of political capital on the migration behavior of peasant households in China’s equitable urbanization. While existing research has proven that political capital can increase the wages of migrant workers, leading to a higher possibility of their rural-to-urban migration, the direct impact of political capital on migration behavior has not received sufficient attention. As China is one of the largest emerging economies, the impact of political capital on the economy and political transformation is typical. This paper reports a survey of 1120 farmer households from Xinxiang, a traditional agricultural area in central China. Using a binary logit model to test whether peasant households will migrate and a multinomial logit model to test where they will migrate to, this study examined whether political capital had a significant influence on the migration behavior of peasant households. The results suggest that the peasant households with political capital have a higher possibility of moving to urban areas, even though there is a better habitational option, namely, a new village in the local rural area. This suggests that reducing the difference in the political capital of migrants through policy propaganda and other methods is an efficient and effective way to achieve and improve equitable access to urbanization.

This chapter illustrates how human rights principles can help governments, even those with the most modest budgets, scale-up universal access to expensive essential medicines. The key message is that governments have legally binding human rights obligations to immediately take steps to provide essential medicines. These steps include making a maximum of public resources available to finance essential medicines, particularly for vulnerable and marginalised groups, and using those resources efficiently. Crucially, using mechanisms to control medicines prices and, in the case of high priced patented medicines, the use of TRIPS flexibilities, is aligned with governments’ duties under human rights law to ensure access to essential medicines. Moreover, the right to health imposes duties on the international community of States and the pharmaceutical industry to respect and protect access to essential medicines.

This qualitative case study analyzes the underrepresentation of minority students in Advanced Placement (AP) courses in Virginia high schools and examines the influences that encourage school leaders to lessen the existing gaps at their assigned schools. Data from a division in southeastern Virginia summarizing each school's minority representation in its AP courses were analyzed. After identifying the schools' minority representation levels, qualitative research methods were used to determine the impact, if any, of school leaders on student participation rates. Additionally, qualitative data from individual interviews were considered to determine if school leaders who had a higher representation of minority populations at their schools demonstrated intentional actions to address AP participation in their schools. The results of this study indicate that principals believed that all capable students should have access to AP courses and that teachers and counselors influence students' decisions to enroll in AP courses. Additionally, principals found that sharing data reflecting their school's representation rates helped justify the need to improve student participation in AP courses. Principals with high participation rates placed importance on communicating to students the opportunities obtained by participating in AP courses and expected school staff to encourage students with potential to participate in more rigorous courses. Principals with higher minority representation rates in advanced courses were also found to frequently remind a variety of stakeholders to encourage students to participate in AP courses. Furthermore, principals with higher minority representation in AP programs used more "we," "us," and "our" statements and references to a team approach when asked about their work. Finally, this study found that specialized academies create environments where stronger student representation rates can occur in AP courses for all student groups. The results of the study have the potential to impact high school leaders as they seek to improve outcomes for the students they serve. Ed. D.

Personalized medicine promises that an individual's genetic information will be increasingly used to prioritize access to health care. Use of genetic information to inform medical decision making, however, raises questions as to whether such use could be inequitable. Using breast cancer genetic risk prediction models as an example, on the surface clinical use of genetic information is consistent with the tools provided by evidence-based medicine, representing a means to equitably distribute limited health-care resources. However, at present, given limitations inherent to the tools themselves, and the mechanisms surrounding their implementation, it becomes clear that reliance on an individual's genetic information as part of medical decision making could serve as a vehicle through which disparities are perpetuated under public and private health-care delivery models. The potential for inequities arising from using genetic information to determine access to health care has been rarely discussed. Yet, it raises legal and ethical questions distinct from those raised surrounding genetic discrimination in employment or access to private insurance. Given the increasing role personalized medicine is forecast to play in the provision of health care, addressing a broader view of what constitutes genetic discrimination, one that occurs along a continuum and includes inequitable access, will be needed during the implementation of new applications based on individual genetic profiles. Only by anticipating and addressing the potential for inequitable access to health care occurring from using genetic information will we move closer to realizing the goal of personalized medicine: to improve the health of individuals.

The growth of the private sector in higher education in Europe – in terms of the number of institutions and the share of enrolments in national systems – has been an educational phenomenon of post-communist transition countries. As Daniel C. Levy (2010: 10) points out, though: “one of the key trends in international higher education, the rapid expansion of the private sector now holds one-third of all global enrollments. However, the growth is not unbroken or inexorable and sometimes stalls and even reverses”. Poland is an example of the reversal in question. While the expansion era (1990-2005) was characterized by external privatization (that is, private sector growth, combined with internal privatization, or the increasing role of fees in the operating budgets of public universities), the current contraction era (2005-2025, and possibly beyond) is characterized by what we term “de-privatization”. De-privatization also has external and internal dimensions: the gradual decline in private sector enrolments is combined with a decreasing role of fees in public universities. The private sector in Poland cannot be explored outside of the context of the public sector: its future is closely linked to the changing public–private dynamics in the whole system. It is useful to explore its future in the context of two major ongoing processes: large-scale reforms of public higher education, and broad, long-term demographic changes. The Polish case study is important for several reasons: the public–private dynamics is rapidly changing in a system which has the highest enrolments in the private sector in the European Union today. In the global context of expanding higher education systems there are several systems in Central and Eastern Europe, and Poland is the biggest of those which are actually contracting. Their contraction is fundamental and rooted in declining demographics. In the global (rather than European) context of increasing reliance on cost-sharing mechanisms and on the private sector growth paradigm in university funding, the Polish system seems to be moving in the opposite direction: global trends towards privatization can be juxtaposed with the Polish counter-trend towards de-privatization.

This study examines the trends in mathematics learning for Grade 4 pupils in Ethiopia based on a longitudinal survey of 33 schools from 2012-13 to 2018-19. The study employs unique data collected both at the start and end of the General Education Quality Improvement Program – Phase II (GEQIP-II) reform targeting the same schools in six regions. The data included repeated measures of pupil learning outcomes plus child socio-economic background, teacher, and school characteristics. Despite the implementation of the GEQIP-II reform, we found that pupils’ mathematics learning levels declined between 2012-13 and 2018-19. Progress in mathematics within the 2018-19 academic year improved slightly compared to 2012-13, but there is difference in magnitude of learning progress for the two periods between pupils across rural-urban locations, regional states, and family economic backgrounds. There is an overall improvement in school and teacher ‘quality’ between 2012 and 2019, while there is some evidence of changes in student composition between the two periods. Consistent with the GEQIP-II reform in terms of supporting access and retention, pupils in 2018-19 were more likely to have attended pre-school, less often absent from school, and less likely to have dropped out, compared to pupils in the same grade level in 2012-13. In 2018-19, pupils’ caregivers are less likely to be literate, they have fewer assets at home, and they travel a relatively longer distance to school. Differences in mathematics learning levels and learning progress between disadvantaged pupils (i.e., pupils from rural areas, emerging regions, poorest socio-economic background) and their relatively advantaged counterparts are discussed in relation to the GEQIP-II educational reform.