Search

Cholesterol is an essential substance involved in many functions, such as maintaining cell membranes, manufacturing vitamin D on surface of the skin, producing hormones, and possibly helping cell connections in the brain. When cholesterol levels rise in the blood, they can, however, have dangerous consequences. In particular, cholesterol has generated considerable notoriety for its causative role in atherosclerosis, the leading cause of death in developed countries around the world. Homeostasis of cholesterol is centered on the metabolism of lipoproteins, which mediate transport of the lipid to and from tissues. As a synopsis of the major events and proteins that manage lipoprotein homeostasis, this review contributes to the substantial attention that has recently been directed to this area. Despite intense scrutiny, the majority of phenotypic variation in total cholesterol and related traits eludes explanation by current genetic knowledge. This is somewhat disappointing considering heritability estimates have established these traits as highly genetic. Thus, the continued search for candidate genes, mutations, and mechanisms is vital to our understanding of heart disease at the molecular level. Furthermore, as marker development continues to predict risk of vascular illness, this knowledge has the potential to revolutionize treatment of this leading human disease.

One of the most visually striking features of granular materials is their heterogeneous pattern of force transmission, commonly known as force chains. In this paper and its associated talk, we will review several experiments on two-dimensional photoelastic granular materials which highlight methods for making quantitative interparticle forces measurements, theoretical frameworks for interpreting such data, and the specific findings which result from these methods.

Abstract Background Over the past half decade South Africa has been developing, implementing and redeveloping its Lay Health Worker (LHW) policies. Research during this period has highlighted challenges with LHW programme implementation. These challenges have included an increased burden of care for female LHWs. The aim of this study was to explore contemporary LHW policy development processes and the extent to which issues of gender are taken up within this process. Methods The study adopted a qualitative approach to exploring policy development from the perspective of policy actors. Eleven policy actors (policy makers and policy commentators) were interviewed individually. Data from the interviews were analysed thematically. Results Considerations of LHW working conditions drove policy redevelopment. From the interviews it seems that gender as an issue never reached the policy making agenda. Although there was strong recognition that the working conditions of LHWs needed to be improved, poor working conditions were not necessarily seen as a gender concern. Our data suggests that in the process of defining the problem which the redeveloped policy had to address, gender was not included. There was no group or body who brought the issue of gender to the attention of policy developers. As such the issue of gender never entered the policy debates. These debates focused on whether it was appropriate to have LHWs, what LHW programme model should be adopted and whether or not LHWs should be incorporated into the formal health system. Conclusion LHW policy redevelopment focused on resolving issues of LHW working conditions through an active process involving many actors and strong debates. Within this process the issue of gender had no champion and never reached the LHW policy agenda. Future research may consider how to incorporate the voices of ordinary women into the policy making process.

Abstract Background While the past two decades have seen a shift towards evidence-based obstetrics and midwifery, the process through which a culture of evidence-based practice develops and is sustained within particular fields of clinical practice has not been well documented, particularly in LMICs (low- and middle-income countries). Forming part of a broader qualitative study of evidence-based policy making, this paper describes the development of a culture of evidence-based practice amongst maternal health policy makers and senior academic obstetricians in South Africa Methods A qualitative case-study approach was used. This included a literature review, a policy document review, a timeline of key events and the collection and analysis of 15 interviews with policy makers and academic clinicians involved in these policy processes and sampled using a purposive approach. The data was analysed thematically. Results The concept of evidence-based medicine became embedded in South African academic obstetrics at a very early stage in relation to the development of the concept internationally. The diffusion of this concept into local academic obstetrics was facilitated by contact and exchange between local academic obstetricians, opinion leaders in international research and structures promoting evidence-based practice. Furthermore the growing acceptance of the concept was stimulated locally through the use of existing professional networks and meetings to share ideas and the contribution of local researchers to building the evidence base for obstetrics both locally and internationally. As a testimony to the extent of the diffusion of evidence-based medicine, South Africa has strongly evidence-based policies for maternal health. Conclusion This case study shows that the combined efforts of local and international researchers can create a culture of evidence-based medicine within one country. It also shows that doing so required time and perseverance from international researchers combined with a readiness by local researchers to receive and actively promote the practice.

Abstract Background Even though it has been shown that peer support to mothers at home helps to increase exclusive breastfeeding, little is known about the experiences of peer supporters themselves and what is required of them to fulfil their day-to-day tasks. Therefore, a community-based randomised control trial using trained "lay" women to support exclusive infant feeding at home was implemented in three different sites across South Africa. The aim of this paper is to describe the experiences of peer supporters who promote exclusive infant feeding. Methods Three focus group discussions were held, in a language of their choice, with peer supporters. These meetings focused on how the peer educators utilised their time in the process of delivering the intervention. Data from the discussions were transcribed, with both verbatim and translated transcripts being used in the analysis. Results Unlike the services provided by mainstream health care, peer supporters had to market their services. They had to negotiate entry into the mother's home and then her life. Furthermore, they had to demonstrate competence and come across as professional and trustworthy. An HIV-positive mother's fear of being stigmatised posed an added burden - subsequent disclosure of her positive status would lead to an increased workload and emotional distress. Peer supporters spent most of their time in the field and had to learn the skill of self-management. Their support-base was enhanced when supervision focused on their working conditions as well as the delivery of their tasks. Despite this, they faced other insurmountable issues, such as mothers being compelled to offer their infants mixed feeding simultaneously due to normative practices and working in the fields postpartum. Conclusion Designers of peer support interventions should consider the skills required for delivering health messages and the skills required for selling a service. Supportive supervision should be responsive both to the health care task and the challenges faced in the process of delivering it. Trial registration NCT00297150.

Abstract Background Recent years have seen a re-emergence of community health worker (CHW) interventions, especially in relation to HIV care, and in increasing coverage of child health interventions. Such programmes can be particularly appealing in the face of human resource shortages and fragmented health systems. However, do we know enough about how these interventions function in order to support the investment? While research based on strong quantitative study designs such as randomised controlled trials increasingly document their impact, there has been less empirical analysis of the internal mechanisms through which CHW interventions succeed or fail. Qualitative process evaluations can help fill this gap. Methods This qualitative paper reports on the experience of three CHW supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomized controlled trial of infant feeding peer counselling support. Results Our findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors. Conclusions This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field. Such understanding can enhance future policy making, planning and implementation of peer community health worker programmes.

Abstract Background Little is known about the process of knowledge translation in low- and middle-income countries. We studied policymaking processes in Mozambique, South Africa and Zimbabwe to understand the factors affecting the use of research evidence in national policy development, with a particular focus on the findings from randomized control trials (RCTs). We examined two cases: the use of magnesium sulphate (MgSO4) in the treatment of eclampsia in pregnancy (a clinical case); and the use of insecticide treated bed nets and indoor residual household spraying for malaria vector control (a public health case). Methods We used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data. Findings Prior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO4 and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO4 than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO4, and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three countries. Conclusion Translating research knowledge into policy is a complex and context sensitive process. Researchers aiming to enhance knowledge translation need to be aware of factors influencing the demand for different types of research; interact and work closely with key policy stakeholders, networks and local champions; and acknowledge the roles of important interest groups.

Abstract Background Few empirical studies of research utilisation have been conducted in low and middle income countries. This paper explores how research information, in particular findings from randomised controlled trials and systematic reviews, informed policy making and clinical guideline development for the use of magnesium sulphate in the treatment of eclampsia and pre-eclampsia in South Africa. Methods A qualitative case-study approach was used to examine the policy process. This included a literature review, a policy document review, a timeline of key events and the collection and analysis of 15 interviews with policy makers and academic clinicians involved in these policy processes and sampled using a purposive approach. The data was analysed thematically and explored theoretically through the literature on agenda setting and the policy making process. Results Prior to 1994 there was no national maternal care policy in South Africa. Consequently each tertiary level institution developed its own care guidelines and these recommended a range of approaches to the management of pre-eclampsia and eclampsia. The subsequent emergence of new national policies for maternal care, including for the treatment of pre-eclampsia and eclampsia, was informed by evidence from randomised controlled trials and systematic reviews. This outcome was influenced by a number of factors. The change to a democratic government in the mid 1990s, and the health reforms that followed, created opportunities for maternal health care policy development. The new government was open to academic involvement in policy making and recruited academics from local networks into key policy making positions in the National Department of Health. The local academic obstetric network, which placed high value on evidence-based practice, brought these values into the policy process and was also linked strongly to international evidence based medicine networks. Within this context of openness to policy development, local researchers acted as policy entrepreneurs, bringing attention to priority health issues, and to the use of research evidence in addressing these. This resulted in the new national maternity care guidelines being informed by evidence from randomised controlled trials and recommending explicitly the use of magnesium sulphate for the management of eclampsia. Conclusion Networks of researchers were important not only in using research information to shape policy but also in placing issues on the policy agenda. A policy context which created a window of opportunity for new research-informed policy development was also crucial.

The journal is pleased to publish the abstracts of the six finalists of the 2023 Manufacturing and Service Operations Management Society's student paper competition. The 2023 prize committee was chaired by Ersin Korpeoglu (UCL), Simone Marinesi (Wharton), and Nur Sunar (UNC). The judges were Adam Elmachtoub, Adem Orsdemir, Agni Orfanoudaki, Alper Nakkas, Amrita Kundu, Antoine Desir, Antoine Feylessoufi, Anton Ovchinnikov, Anyan Qi, Arian Aflaki, Arzum Akkas, Ashish Kabra, Auyon Siddiq, Bilal Gokpinar, Bin Hu, Bob Batt, Bora Keskin, Brent Moritz, Can Zhang, Chloe Glaeser, Cuihong Li, Daniel Freund, Daniel Lin, David Drake, Divya Singhvi, Dongyuan Zhan, Ekaterina Astashkina, Elena Belavina, Elodie Adida, Emre Nadar, Enis Kayis, Fabian Sting, Fanyin Zheng, Fei Gao, Florin Ciocan, Francisco Castro, George Chen, Georgina Hall, Gloria Urrea, Gonzalo Romero, Guihua Wang, Guoming Lai, Heikki Peura, Hessam Bavafa, Hummy Song, Huseyin Gurkan, Ioannis Stamatopoulos, Iris Wang, Jiankun Sun, Jiayi Joey Yu, Jing Wu, Joel Wooten, John Silberholz, Jonas Oddur Jonasson, Jonathan Helm, Jose Guajardo, Junyu Cao, Kaitlin Daniels, Karen Zheng, Ken Moon, Kostas Bimpikis, Lennart Baardman, Lesley Meng, Lina Song, Luyi Yang, Mazhar Arikan, Mehmet Ayvaci, Meng Li, Mengzhenyu Zhang, Miao Bai, Michael Freeman, Mika Sumida, Ming Hu, Morvarid Rahmani, Mostafa Rezaei, Mumin Kurtulus, Nan Yang, Nazli Sonmez, Negin Golrezaei, Nektarios Oraiopoulos, Nikhil Garg, Nikos Trichakis, Nil Karacaoglu, Olga Perdikaki, Onesun Steve Yoo, Ovunc Yilmaz, Ozan Candogan, Panos Markou, Pengyi Shi, Philipp Cornelius, Qiuping Yu, Renyu Zhang, Robert Bray, Ruth Beer, Ruxian Wang, Saed Alizamir, Safak Yucel, Sanjith Gopalakrishnan, Santiago Gallino, Sarah Yini Gao, Scott Rodilitz, Sebastien Martin, Seyed Emadi, Sheng Liu, Shouqiang Wang, Siddharth Singh, Sidika Candogan, Sina Khorasani, So Yeon Chun, Somya Singhvi, Soo-Haeng Cho, Sriram Dasu, Stefanus Jasin, Stephen Leider, Suresh Muthulingam, Sytske Wijnsma, Taghi Khaniyev, Tian Chan, Tim Kraft, Tom Tan, Tugce Martagan, Vasiliki Kostamj, Velibor Misic, Vishal Agrawal, Xiaojia Guo, Xiaoshuai Fan, Xiaoyang Long, Yannis Bellos, Yao Cui, Yehua Wei, Yiangos Papanastasiou, Yi-Chun Chen, Yinghao Zhang, Ying-Ju Chen, Yinghao Zhang, Yuan-Mao Kao, Yuexing Li, Zhaohui (Zoey) Jiang, Zhaowei She, and Zumbul Atan. [ABSTRACT FROM AUTHOR]

We live in an age of evidence-based medicine [1], and with good reason. It is important to be able to evaluate the likely impact of various interventions, and it is [...]