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One promising approach for mapping CMRO(2) is dual-calibrated functional MRI (dc-fMRI). This method exploits the Fick Principle to combine estimates of CBF from ASL, and OEF derived from BOLD-ASL measurements during arterial O(2) and CO(2) modulations. Multiple gas modulations are required to decouple OEF and deoxyhemoglobin-sensitive blood volume. We propose an alternative single gas calibrated fMRI framework, integrating a model of oxygen transport, that links blood volume and CBF to OEF and creates a mapping between the maximum BOLD signal, CBF and OEF (and CMRO(2)). Simulations demonstrated the method’s viability within physiological ranges of mitochondrial oxygen pressure, P(m)O(2), and mean capillary transit time. A dc-fMRI experiment, performed on 20 healthy subjects using O(2) and CO(2) challenges, was used to validate the approach. The validation conveyed expected estimates of model parameters (e.g., low P(m)O(2)), with spatially uniform OEF maps (grey matter, GM, OEF spatial standard deviation ≈ 0.13). GM OEF estimates obtained with hypercapnia calibrated fMRI correlated with dc-fMRI (r = 0.65, p = 2·10(−3)). For 12 subjects, OEF measured with dc-fMRI and the single gas calibration method were correlated with whole-brain OEF derived from phase measures in the superior sagittal sinus (r = 0.58, p = 0.048; r = 0.64, p = 0.025 respectively). Simplified calibrated fMRI using hypercapnia holds promise for clinical application.

Purpose: The purpose of this study was to describe and examine parent views of speech-language pathology (SLP) for children born with cleft palate delivered via telemedicine during the COVID-19 pandemic in the United Kingdom (UK). Method: Parents were asked whether they found this method of delivery “very effective,” “somewhat effective,” or “not at all effective.” Free text was then invited. There were 212 responses. Ordinal chi-square, Kruskal–Wallis, or Fisher's exact tests examined associations between parent views of effectiveness and biological variables and socioeconomic status. Free text responses were analyzed using qualitative content analysis. Results: One hundred and forty (66.0%) respondents reported that SLP delivered via telemedicine was “somewhat effective,” 56 (26.4%) “very effective,” and 16 (7.6%) “not at all effective.” There was no evidence of an association between parent reported effectiveness and any of the explanatory variables. Parent-reported challenges impacting on effectiveness included technology issues and keeping their children engaged with sessions. Importantly, telemedicine was viewed as “better than nothing.” Conclusions: Most parents reported that they felt SLP delivered via telemedicine during the first few months of the COVID-19 pandemic in the UK was at least “somewhat effective.” It is important to interpret this in the context of there being no other method of service delivery during this time and that this study only represents families who were able to access SLP delivered via telemedicine. Further work is needed to identify which children with cleft palate might benefit from SLP delivered via telemedicine to inform postpandemic service provision.

One promising approach for mapping CMRO2 is dual-calibrated functional MRI (dc-fMRI). This method exploits the Fick Principle to combine estimates of CBF from ASL, and OEF derived from BOLD-ASL measurements during arterial O2 and CO2 modulations. Multiple gas modulations are required to decouple OEF and deoxyhemoglobin-sensitive blood volume. We propose an alternative single gas calibrated fMRI framework, integrating a model of oxygen transport, that links blood volume and CBF to OEF and creates a mapping between the maximum BOLD signal, CBF and OEF (and CMRO2). Simulations demonstrated the method’s viability within physiological ranges of mitochondrial oxygen pressure, PmO2, and mean capillary transit time. A dc-fMRI experiment, performed on 20 healthy subjects using O2 and CO2 challenges, was used to validate the approach. The validation conveyed expected estimates of model parameters (e.g., low PmO2), with spatially uniform OEF maps (grey matter, GM, OEF spatial standard deviation ≈ 0.13). GM OEF estimates obtained with hypercapnia calibrated fMRI correlated with dc-fMRI (r = 0.65, p = 2·10−3). For 12 subjects, OEF measured with dc-fMRI and the single gas calibration method were correlated with whole-brain OEF derived from phase measures in the superior sagittal sinus (r = 0.58, p = 0.048; r = 0.64, p = 0.025 respectively). Simplified calibrated fMRI using hypercapnia holds promise for clinical application.

Since 2011, the war in Syria has resulted in the displacement of 12.2 million people. Over 5.6 million have fled Syria to seek asylum in neighbouring countries, while 6.6 million have been internally displaced. Family separation, with significant psychological, social and economic implications, is a key concern for those who flee violence and cross international borders. This qualitative study sought to understand the causes of separation among Syrian families in Jordan and the obstacles to family reunification. Semi-structured, in-depth interviews were conducted with 85 Syrian refugee families identified as having separated family members. We present critical moments during migration when family separation occurs: (1) while fleeing Syria, (2) while residing in Jordan and (3) pre-existing separation due to work or travel that was exacerbated by the conflict. We also highlight the factors that perpetuate separation among families, preventing or delaying them from reuniting. These findings may help to inform more humane family reunification practices as well as identify future research and learning needs.

Effective communication about medical countermeasures—including drugs, devices and biologics—is often critical in emergency situations. Such communication, however, does not just happen. It must be planned and prepared for. One mechanism to develop communication strategies is through the use of prospective scenarios, which allow readers the opportunity to rehearse responses while also weighing the implications of their actions. This article describes the development of such a scenario: The SPARS Pandemic 2025-2028. Steps in this process included deciding on a timeframe, identifying likely critical uncertainties, and then using this framework to construct a storyline covering both the response and recovery phases of a fictional emergency event. Lessons learned from the scenario development and how the scenario can be used to improve communication are also discussed.

Cerebrovascular dysregulation such as altered cerebral blood flow (CBF) can be observed in Alzheimer's disease (AD) and may precede symptom onset. Genome wide association studies show that AD has a polygenic aetiology, providing a tool for studying AD susceptibility across the lifespan. Here, we ascertain whether the AD genetic risk effects on CBF previously observed (Chandler et al., 2019) are also present in later life. Consistent with our prior observations, AD genetic risk score (AD-GRS) was associated with reduced CBF in the ADNI sample. The regional association between AD-GRS and CBF were also spatially similar. Furthermore, CBF was related to the regional mRNA transcript expression of AD risk genes proximal to AD-GRS risk loci. These observations suggest that AD risk alleles may reduce neurovascular process such as CBF, potentially via mechanisms such as regional expression of proximal AD risk genes as an antecedent AD pathophysiology. Our observations help establish processes that underpin AD genetic risk-related reductions in CBF as a therapeutic target prior to the onset of neurodegeneration.

OBJECTIVES. To gather lessons from the communities that responded to confirmed cases of Ebola Virus Disease (EVD) in the United States in order to inform recommendations to improve resilience to future High Consequence Infectious Disease (HCID) events. METHODS. Key informant interviews (n=73) were conducted between February and November 2016 with individuals who participated in EVD planning or response in Atlanta, Georgia; Dallas, Texas; New York, New York; or Omaha, Nebraska. Participants represented healthcare; local, state, and federal public health; law; local and state emergency management; academia; local and national media; and local and state government. Two focus groups were then conducted in New York and Dallas, and study results were vetted with an expert advisory group. Accounts from the domestic Ebola response and recommendations for future events were used to develop an evidence-informed checklist that outlines specific actions for public health authorities. RESULTS. Participants focused on a number of important areas to improve public health resilience to HCID events, including governance and leadership, communication and public trust, quarantine and the law, monitoring programs, environmental decontamination, and waste management. CONCLUSIONS. The direct experiences of select jurisdictions recently engaged in EVD response provided a rare opportunity for collective learning and the development of a concrete list of actions with which to strengthen of public health resilience to future HCID events.

National investments to facilitate prompt access to safe and effective medical countermeasures (MCMs) (ie, products used to diagnose, prevent, protect from, or treat conditions associated with chemical, biological, radiological, or nuclear threats, or emerging infectious diseases) have little merit if people are not willing to take a recommended MCM during an emergency or inadvertently misuse or miss out on a recommended MCM during an emergency. Informed by the Expert Working Group on MCM Emergency Communication, the Johns Hopkins Center for Health Security developed recommendations for achieving desired public health outcomes through improved MCM communication based on a review of model practices in risk communication, crisis communication, and public warnings; detailed analysis of recent health crises involving MCMs; and development of a scenario depicting future MCM communication dilemmas. The public’s topics of concern, emotional requirements, capacity for processing information, and health needs will evolve as an emergency unfolds, from a pre-event period of routine conditions, to a crisis state, to a post-event period of reflection. Thus, MCM communication by public health authorities requires a phased approach that spans from building up a reputation as a trusted steward of MCMs between crises to developing recovery-focused messages about applying newly acquired data about MCM safety, efficacy, and accessibility to improve future situations.

Background Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions – urban-based refugees, stressed host-country health systems and high NCD prevalence. Although several studies have explored NCD prevalence, utilization of services and barriers to access, these analyses took place prior to dramatic shifts in Jordanian health policy and did not account for nuances in health seeking and utilization behaviors or operational barriers. Accordingly, we aimed to understand the depth and nuances of Syrian refugees’ experiences accessing NCD services in urban and semi-urban settings in Jordan. Methods A qualitative study was conducted to explore the healthcare experiences of Syrian refugees in Jordan. The study team conducted 68 in-depth interviews with Syrian refugees in urban and semi-urban locations in central and northern Jordan. Results The findings indicated four themes key to understanding the healthcare experience: (1) emotional distress is a central concern and is frequently highlighted as the trigger for a non-communicable disease or its exacerbation; (2) service provision across all sectors – government, NGO, private – is complex, inadequate, expensive and fragmented, making engagement with the health sector physically and financially burdensome; (3) given financial constraints, participants make harmful decisions that further damage their health in order to reduce financial burdens, and (4) host-community members actively exhibit solidarity with their refugee neighbors and specifically do so during emergency health episodes. The findings from this study can be used to inform program design for forcibly displaced persons with NCDs and identify points of entry for effective interventions. Conclusions Opportunities exist for humanitarian and host-country actors to provide more comprehensive NCD services and to improve the relevance and the quality of care provided to Syrian refugees in Jordan. Global and national funding will need to align with front-line realities and foster better coordination of services between host-country health systems, private actors and non-governmental organizations.

Background The domestic response to the West Africa Ebola virus disease (EVD) epidemic from 2014-2016 provides a unique opportunity to distill lessons learned about health sector planning and operations from those individuals directly involved. This research project aimed to identify and integrate these lessons into an actionable checklist that can improve health sector resilience to future high-consequence infectious disease (HCID) events. Methods Interviews (N = 73) were completed with individuals involved in the domestic EVD response in 4 cities (Atlanta, Dallas, New York, and Omaha), and included individuals who worked in academia, emergency management, government, health care, law, media, and public health during the response. Interviews were transcribed and analyzed qualitatively. Two focus groups were then conducted to expand on themes identified in the interviews. Using these themes, an evidence-informed checklist was developed and vetted for completeness and feasibility by an expert advisory group. Results Salient themes identified included health care facility issues—specifically identifying assessment and treatment hospitals, isolation and treatment unit layout, waste management, community relations, patient identification, patient isolation, limitations on treatment, laboratories, and research considerations—and health care workforce issues—specifically psychosocial impact, unit staffing, staff training, and proper personal protective equipment. Conclusions The experiences of those involved in the domestic Ebola response provide critical lessons that can help strengthen resilience of health care systems and improve future responses to HCID events.

This article was written by Hannah Chandler, the Official Papers Librarian for the Bodleian Libraries. Her article looks at how the print collections were managed in the past and how the collections are managed and arranged today in Oxford. It looks at the complex and dynamic environment of official publishing in terms both of print and e-format. Looking to the future, it considers how shared working practices and policy on giving access to and archiving born digital material are benefitting the legal deposit libraries. Finally, the article outlines the breadth of the challenge, not only giving access to information in perpetuity but also making it accessible to the information professional and user.