This article presents a qualitative, exploratory inquiry into existing linkages in Regional and LocalEconomic development (RandLED) facilitation systems in South Africa. The authors argue that although a natural overlap is present between these systems, the complexity of the environment, comprising multi-stakeholders and multi-levels, represents a governance challenge. Resolving, or bridging this gap, requires the adoption of specific, innovative approaches. Three case study examples of governance interventions in the Western Cape province of South Africa are discussed, in order to gain an insight into how they attempted to create institutional synergy in RandLED. The article concludes with observations and recommendations for RandLED policy and practice, to aid in synthesising implementation processes and ultimately the delivery of improved development outcomes. The authors suggest that innovative partnerships, based on collaboration and collaborative governance between role-players in the RandLED arena, should be explored in more detail, as well as being recognised in economic development policy processes.
Background: The association between maternal and infant dietary exposures and risk of allergic disease development is an area of considerable scientific uncertainty. Objective: This study aims to compare dietary habits during pregnancy and lactation in two pre-birth cohorts from the same location approximately 10 years apart, a timeframe characterised by changes in government dietary advice. Methods: The FAIR cohort is an unselected birth cohort born between 2001-2002. The 3rd generation cohort was born between 2010-2018. Both cohorts were established on the Isle of Wight (UK) to investigate prevalence of allergic diseases. Nutrition and allergy data was collected prospectively from recruitment and throughout the infant's early life. Here we present dietary data collected in the third trimester of pregnancy and at three months of age. Differences between cohorts were tested using t-tests, Wilcoxon rank sum tests, chi-squared and Fisher's exact tests. Results: Data was available for 1331 participants (969 FAIR and 362 3rd generation). The proportion of mothers that reported excluding peanuts during pregnancy was significantly lower for the 3rd generation compared to the FAIR cohort (16.0% vs. 55.6%, p < 0.01). Cohort membership, primiparity, and maternal education were significantly associated with excluding peanuts during pregnancy (p < 0.01). The proportion of mothers who reported excluding any foods during breastfeeding was significantly lower for the 3rd generation compared to the FAIR cohort (22.8% vs. 43.4%, p < 0.01). Conclusion: Maternal exclusion of peanut during pregnancy was lower for mothers giving birth between 2012-2018, compared to mothers giving birth between 2001-2002.
There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the "second translational gap". A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care. We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers. The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.
Introduction Food hypersensitivity (FHS), including food allergy, coeliac disease and food intolerance, is a major public health issue. The Food Standards Agency (FSA), an independent UK Government department working to protect public health and consumers' wider interests in food, sought to identify research priorities in the area of FHS. Methods A priority setting exercise was undertaken, using a methodology adapted from the James Lind Alliance—the first such exercise with respect to food hypersensitivity. A UK-wide public consultation was held to identify unanswered research questions. After excluding diagnostics, desensitization treatment and other questions which were out of scope for FSA or where FSA was already commissioning research, 15 indicative questions were identified and prioritized by a range of stakeholders, representing food businesses, patient groups, health care and academia, local authorities and the FSA. Results 295 responses were received during the public consultation, which were categorized into 70 sub-questions and used to define 15 key evidence uncertainties ('indicative questions') for prioritization. Using the JLA prioritization framework, this resulted in 10 priority uncertainties in evidence, from which 16 research questions were developed. These could be summarized under the following 5 themes: communication of allergens both within the food supply chain and then to the end consumer (ensuring trust in allergen communication); the impact of socio-economic factors on consumers with FHS; drivers of severe reactions; mechanism(s) underlying loss of tolerance in FHS; and the risks posed by novel allergens/processing. Discussion In this first research prioritization exercise for food allergy and FHS, key priorities identified to protect the food-allergic public were strategies to help allergic consumers to make confident food choices, prevention of FHS and increasing understanding of socio-economic impacts. Diagnosis and treatment of FHS was not considered in this prioritization.
A search for dark matter linelike signals iss performed in the vicinity of the Galactic Center by the H.E.S.S. experiment on observational data taken in 2014. An unbinned likelihood analysis iss developed to improve the sensitivity to linelike signals. The upgraded analysis along with newer data extend the energy coverage of the previous measurement down to 100 GeV. The 18 h of data collected with the H.E.S.S. array allow one to rule out at 95% C.L. the presence of a 130 GeV line (at l=-1.5°, b=0° and for a dark matter profile centered at this location) previously reported in Fermi-LAT data. This new analysis overlaps significantly in energy with previous Fermi-LAT and H.E.S.S. RESULTS: No significant excess associated with dark matter annihilations was found in the energy range of 100 GeV to 2 TeV and upper limits on the gamma-ray flux and the velocity weighted annihilation cross section are derived adopting an Einasto dark matter halo profile. Expected limits for present and future large statistics H.E.S.S. observations are also given. ; The support of the Namibian authorities and of the University of Namibia in facilitating the construction and operation of H.E.S.S. is gratefully acknowledged, as is the support by the German Ministry for Education and Research (BMBF), the Max Planck Society, the German Research Foundation (DFG), the French Ministry for Research, the Centre National de la Recherche Scientifique-Institut National de Physique Nucléaire et de Physique des Particules and the Astroparticle Interdisciplinary Programme of the Centre National de la Recherche Scientifique, the United Kingdom Science and Technology Facilities Council (STFC), the Institute of Particle and Nuclear Physics of the Charles University, the Czech Science Foundation, the Polish Ministry of Science and Higher Education, the South African Department of Science and Technology and National Research Foundation, and the University of Namibia. We appreciate the excellent work of the technical support staff in Berlin, Durham, Hamburg, Heidelberg, Palaiseau, Paris, Saclay, and Namibia in the construction and operation of the equipment. R. C. G. Chaves Funded by European Union Seventh Framework Programme Marie Curie, Grant Agreement No. PIEF-GA-2012-332350. ; Peer-reviewed ; Publisher Version
