A warm welcome to all our new students – we look forward to supporting in your studies this year!
There is a lot of information for new arrivals to take in during orientation week. When you have had a chance to catch your breath, come along to the Library any time when we are open – all the staff here will be happy to help you with anything related to our study facilities, information resources and information skills training.
To make sure that you can hit the ground running, you should attend our information skills classesin weeks 1 and 2. These classes are aimed at Masters level students, but anybody is welcome to attend. The classes are:
Session1: Using the Library & finding items on your reading list
This class will give you an introduction to the Library, help you to understand your reading list, and find and access print and electronic material in the Library.
This class is offered twice a day from Monday 1 October – Friday 5 October, at 1:00pm-2:00pm and5:30pm-6:30pm.
Session 2: Introduction to effective literature searching
This class provides an introduction to literature searching skills, helping you to search more effectively and efficiently.
This class is offered twice a day from Monday 8 October – Friday 12 October, at 1:00pm-2:00pm and 5:30pm-6:30pm.
All of the classes are held in the Barnard Room in the Library.
You only need to come to one session of each class, whenever is most convenient for you. Book your place online:
A Gaussian repeated measures model with one or several unstructured covariance matrices is fitted using proc MCMC sampling directly based on conjugate priors. Any missing values for subject visits with no response are imputed and directly available in the imputed data set.
Main restriction is that every subject uses the same covariance matrix throughout their series of visits.
Data is input in vertical form just like proc MIXED.
The main application is the modelling of off-treatment data, and other situations where the actual treatment changes across visits. Subsequent analysis will usually be based on multiple imputation techniques. The tools can also be used to fit many of the models usually fitted using the GSK 5 macros.
The implementation is fast (about ten times faster than GSK 5 macros) and leads to chains with very little auto-correlation.
The following files are contained in a zip file downloaded as RMConj_19180827.
1) RMConj_Explained1.pdf. A description of the tool and the methods used.
2) RMConj32.sas. The SAS code for the macro. The header includes a detailed description and development history.
3) MIAnalze04.sas. Macro used in examples for combining results multiple imputations.
4) Demo1.sas is an example program file that does MAR, J2R and CIR analyses to the standard DIA example data set chapter15_example.sas7bdat. Results are in file Demo1-results.pdf.
5) RMC_FollowOn1.sas is an example program outlining the analysis including follow-up observations after treatment withdrawal. Data set fudata1.sas7bdat is an expanded version of the DIA data. set based on a J2R model. Results are in the file RMC_FollowOn1-results.pdf.
Last week, we headed to Glasgow for the BSA Medical Sociology Annual Conference to share a sneak preview of our findings from This Sickle Cell Life: voices and experiences of young people with sickle cell.
Sickle cell disease is a genetic blood disorder disproportionately found in minority ethnic communities in Britain. It is a chronic debilitating condition that both causes cumulative damage to multiple organ systems, and causes acute pain.
This Sickle Cell Life is part of the work of DEPTH research group at LSHTM. The project explores how people move from using child to adult healthcare services and asks young people about their experiences of living with sickle cell. Transitioning to adulthood is obviously not just something that affects clinical experiences and so we also explore education and relationships, and ask young people what is important to them.
At the BSA MedSoc conference we talked about how healthcare transitions shape the identity of young people, and how these transitions help ‘make’ particular kinds of patients.
Why focus on identity? Health transitions need new health knowledge and new behaviours to develop, but they also need development of self-perceptions and understandings of how a person should behave as an adult (rather than a child) patient. In this way, identities play an important role in shaping health practices and beliefs. Understanding identity development during transitions can help explain why some young people transition smoothly or less smoothly into healthy adulthood.
In our presentation, we talked about how ideas and discourses about self-management and healthy lifestyle within healthcare today act as a way to discipline young people “at a distance”, to quote Miller & Rose (1990) and influence their behaviour. These healthcare self-management discourses intersect with demands from schools that are often not compatible. For instance, schools demand that young people excel and become entrepreneurial, competent individuals, but excelling at school is far more difficult for young people who have to spend time in hospital, or who have to rest regularly to avoid having a pain crisis. These intersecting demands can translate into conflicting “self-disciplining” identities.
For young people with sickle cell, we found that transitions to adulthood involve relentless self-disciplining and self-surveillance to try to be as healthy as possible, while also aspiring to work hard so that they can develop and meet educational and career goals.
You can check back on our updates from the BSA conference on the Sickle Cell LifeTwitter account, here.
Pauline Paterson joined an expert panel on BBC’s Newsnight, discussing latest figures revealing a fall in proportion of children in England getting the MMR vaccination: “Vaccines are a victim of their own success and if, for example, a parent doesn’t see the disease within a community, they may not feel the need to vaccinate their child.” Pauline is quoted by The Times (£) on the latest figures from the NHS.
Heidi Larson also discusses vaccine confidence this week in an article by Buzzfeed News exploring vaccine hesitancy in Europe compared to the United States: “While that outbreak from Disneyland was getting all the attention, there were 600 cases in Berlin, and no one said anything.” Heidi’s comments are also published by IFL Science.
Martin McKee is interviewed on BBC Radio 4’s Today programme (from 1h10m) on Public Health England’s decision to launch a campaign with Drinkaware, a charity partly funded by the alcohol industry. Martin said: “The tie-up with Public Health England does give the alcohol industry a lot of credibility. It says we are part of the solution when clearly they are not.” Martin’s interview generates coverage in The Guardian and Daily Telegraph.
Catherine McGowan speaks to the Associated Press on the use of fentanyl test strips that can help heroin users to detect the contaminant and avoid overdose: “Anything that empowers people who inject drugs to mitigate their own risk is a good thing, You just need to be really careful.” The article generates coverage in over 200 articles worldwide including The New York Times, Fox News (US), National Post (Canada), Daily Mail and Times of India.
James Logan joins BBC’s The One Show (from 24m), discussing the latest research into how body odour could be key to understanding why some of us are more attractive to mosquitoes than others.
James Logan is also quoted in the Daily Telegraph on how experts are aiming to find out more about the causes of the Zika virus to improve outbreak preparedness: “Zika took everyone by surprise in 2015. We need to understand what happened so we’re better prepared in future. It’s an interesting time, with experts from many different disciplines collaborating to put the puzzle of this virus together.”
Hannah Kuper also speaks to the Daily Telegraph on research she carries out with families affected by Zika. Hannah’s work aims to improve understanding of the societal and economic impacts the disease has had in Brazil: “Generally, the attitude towards people with disabilities in Brazil is very negative but Zika has helped raise the profile of other disabilities and we have seen a real shift in attitudes.”
Rachel Lowe and Chris Drakeley join the TRT World Roundtable panel, discussing the growing threat of tropical disease outbreaks linked to rising temperatures due to climate change. Rachel also provides comment to Inter Press Service on the topic: “People are becoming more aware of infectious diseases in general, but probably not so aware of the fact there are certain infectious diseases in Europe.”
Brendan Wren speaks to BBC Breakfast on post-mortem results showing that a British couple died in Egypt from complications associated with E. coli infection.
Antonio Gasparrini is quoted by Thomson Reuters on new LSHTM-led research that shows the meet the climate goals set out in the Paris Agreement, or more people could die because of extreme temperatures: “Currently, we are on a trajectory to reach over 3 degrees Celsius of warming, and if this trend continues there would be serious consequences for health in many parts of the world.”
Nature report a new LSHTM-led study that explores the mechanism that allows the diarrhoea-causing bacterium Clostridium difficile to disrupt the gut’s natural microbial balance.
LSHTM experts comment on findings presented at the European Respiratory Society congress this week:
Neil Pearce provides comment on findings that suggests giving paracetamol to children under two could increase the risk of developing asthma as a teenager. He said: “The problem is that children are not given paracetamol early in life for no reason. They are often given it because they have respiratory infection. It may be the infection which increases the risk of asthma.” Neil’s comments are reported widely by UK media including ITV News, The Times (£), Daily Mail, Daily Telegraph and an article by the Press Association generates coverage in over 150 UK outlets.
Stephen Evans provides comment on trial results that show there is no benefit to elderly people in good health to take an aspirin per day: “They also show that benefits of aspirin in healthy people are at best limited, and may well be harmful, and this harm may be increased beyond age 73.” Stephen’s comments are published by The Guardian, Daily Telegraph and The Times (£).
On social media
This week’s social media highlight is from LSHTM’s Instagram account and is a repost of Seacole Social’s first post since re-opening for the academic year. With a new menu, fairtrade, organic coffee and some new faces, Seacole Social is open to all from 8am-4pm Monday-Friday. Be sure to follow their Instagram account for menu and deals updates!
Despite widespread media attention, repeated public health alerts, and the US President’s declaration of the opioid overdose epidemic as a ‘public health emergency’, fatal overdoses continue to rise.
A key factor is pharmaceutical fentanyl – a powerful synthetic opioid commonly used in clinical settings to reduce moderate to severe pain. Since 2014 illegally manufactured fentanyl, and many of its analogues, have been used to adulterate street drugs, principally heroin. Fentanyl is considerably more potent by weight than heroin and has been responsible for a significant number of fatal drug overdoses in North America since 2015.
Preliminary data released by the Centres for Disease Control and Prevention suggest that in 2016 more than 20,000 people died from unintentional overdoses involving synthetic opioids (not including methadone) in the United States. In Canada, 3,671 people died from unintentional overdose in 2017 – 72% of these deaths can be attributed to fentanyl or fentanyl analogues.
So what can be done?
Harm reduction agencies in North America have begun to distribute test-strips which, when dipped in a drug solution, are able to detect fentanyl and many of its analogues. Is this a potential answer to the overdose problem? Perhaps; but caution is required.
First, research suggests that while self-testing technologies may be accurate in a laboratory, they may be considerably less effective when used in a real-life setting. Contamination, for example with injecting equipment, is more likely to occur in a street setting than a laboratory.
Second, the test strips are only able to indicate whether or not fentanyl is present in a drug solution, they do not indicate how much fentanyl is present. In cases where a comparatively large proportion of a drug is fentanyl, ‘test hits’ taken by users to reduce their risk of overdose in response to a positive test may be ineffective in reducing the risk of overdose.
Third, while some test strips have demonstrated greater than 95% accuracy, this still leaves the possibility of a false negative in one in twenty tests of fentanyl-adulterated drugs. People may inject heroin up to five times a day rendering false-negative a fairly regular occurrence. Additionally, test strips have shown to have a low detection limit, a drug sample may test positive when a minimal amount of fentanyl is present. There is a risk that users may not consistently modify behaviour if drugs are routinely testing positive without producing the anticipated psychoactive effect.
Fourth, not all test strips are created equal. DanceSafe, a US-based public health organisation, in conjunction with the University of California San Francisco, tested five fentanyl test strips from three different manufacturers and found that four of the test strips did not detect carfentanil (a fentanyl analogue that is considerably more potent by weight than fentanyl); one test strip did not work at all.
The need to tackle the fentanyl crisis is clear. A recent drug-checking pilot carried out in Vancouver found that 90.6% of drugs submitted tested positive for fentanyl. Though fentanyl was most commonly found in heroin, it was identified in other street drugs as well, including: amphetamines, methamphetamines, crack, and cocaine.
And the problem is not confined to North America. Since 2014, six fentanyl variations have been identified in the UK, with several overdoses attributed to fentanyl occurring in the North East of England in 2017.
But should we be promoting test strips as a potential solution to the crisis?
In June 2018 Health Canada cautioned against relying on test strips alone, suggesting that other precautions were necessary to prevent overdose including: never consuming alone, consuming a lower dose – “start low and go slow”, and only using drugs in the presence of someone who is equipped with, and knowledgeable about the administration of, naloxone.
Providing appropriate messaging on how to interpret test results and their limitations is key. We must understand more about the accuracy and acceptability of fentanyl self-testing, and research should also aim to inform the development of an effective means of dispensing test strips – and associated risk-reduction measures – to those who do not regularly come into contact with harm reduction services. Education and appropriate harm reduction messaging to mitigate against the risk of false negatives alongside strategies to prevent or reverse overdose is crucial.
There is huge potential in self-testing technology but it must be used as part of a package of risk-reduction measures. The problem is clear but the answers are not.
“Children’s work and parental investment in education in north-western Tanzania”
Abstract: Changes associated with modernisation, including livelihood change, urbanisation, and the introduction of formal education, reduce children’s ability to contribute to their households, and produce a trade-off between work and learning. Increasingly high levels of investment in education are thought to raise the costs of children, resulting in a ‘quantity-quality trade-off’ which incentivises reduced fertility. Relatively few studies have examined children’s time allocation in contemporary transitioning populations, where education is available and valued, but where subsistence livelihoods still create demand for children’s work. This study collected time allocation data from 1,278 children living in two communities in a rapidly modernising setting in Mwanza region, Tanzania. Focus group discussions were also conducted to investigate the perceived costs and benefits of education for parents and adolescents.
The findings from this research highlight the importance of considering children’s work in providing a more nuanced understanding of variation in education. Lower-than- anticipated trade-offs between work and school suggest the opportunity costs of school in this context may be relatively low, potentially contributing to the stalled fertility decline. Households may balance work and schooling demands through substitution between co-resident children, and through fostering networks, with implications for classic models of fertility decline which focus mainly on parental investment. Girls’ household work involves a sacrifice of leisure time and does not appear to diminish significantly with modernisation, suggesting the need to challenge gender stereotypes, and reduce the domestic work burden in transitioning contexts. Finally, education is highly valued, but the barriers to academic achievement mean that few experience the desired benefits, pointing to the importance of improving employment prospects together with providing good-quality, locally relevant schooling.
“Point-of-contact interactive record linkage between demographic surveillance and health facilities to measure patterns of HIV service utilisation in Tanzania”
As significant investments and efforts have been made to strengthen HIV prevention and care service provisions throughout sub-Saharan Africa, approaches to monitoring uptake of these services have grown in importance. Currently, estimates of internationally used indicators to track progress and prioritise further programme implementation in sub-Saharan Africa often rely on self-reported health service use as measured in population-based demographic and HIV serological surveillance systems, or are limited to patients already diagnosed and enrolled into clinical care and lack a population perspective.
My thesis augmented existing computer software towards a novel approach to record linkage – termed point-of-contact interactive record linkage (PIRL) – and produced an infrastructure of linked surveillance data and medical records from clinics located within a surveillance area in northwest Tanzania. The methodological portion of this seminar will detail the PIRL software and the data it created, report attributes associated with (un)successful linkage, compare PIRL to a less resource-intensive fully automated linkage approach, and provide original evidence of bias and precision in analyses of linked data with substantial linkage errors. The substantive portion of this seminar will utilise the linked data to critique the estimation of the first UNAIDS 90-90-90 target and compare linkage to care and antiretroviral therapy initiation rates by testing modality among individuals newly diagnosed with HIV.
The collective findings of this thesis demonstrate the feasibility of PIRL in settings with relatively poor data quality and the ability to use the linked data to measure directly-observed patterns of HIV service use in a population.
Rentsch CT, Kabudula CW, Catlett J et al. Point-of-contact Interactive Record Linkage (PIRL): A software tool to prospectively link demographic surveillance and health facility data [version 2; referees: 2 approved]. Gates Open Res 2018, 1:8 (doi: 10.12688/gatesopenres.12751.2)
Point-of-contact interactive record linkage (PIRL) between demographic surveillance and health facility data in rural Tanzania
Our article, ‘Slow co-production’ for deeper patient involvement in health care’, has just been published in the Journal of Health Design. It’s open access so anyone can read it, download it and share it. The article argues that ‘slow co-production’, achieved by involving patients in in-depth research, can help deepen patient involvement in health care. We describe how slow co-production offers a mutually beneficial form of patient and public involvement. It promotes patient-centered knowledge and helps us to examine and reflect on the co-production processes themselves, rather than always rushing to evaluate the end product as if it came into being without a process and a series of human relationships.
The thinking behind this article was our different and shared experiences of time constraints in qualitative fieldwork. We discussed, for example, those times when we felt pressured to move on from fieldwork when we didn’t feel we had been able to fully examine the narratives that we were learning about, or the interviews we were conducting. This restriction to fieldwork research is usually required for budget and time constraints, but it can feel frustrating to have to withdraw from the work being conducted when it feels like there is more to be gained.
More positively, we recognise that we have also experienced opportunities for more thorough, in-depth ‘slow’ research, including the Sickle Cell project that this new article takes as its case study. We believe that this kind of ‘slow’ research, as previously explored in healthcare research by Vincanne Adams et. al (2013) and Heather Mendick (2014) amongst others, is an important antidote to the ever-building pressures that are heaped upon the researcher. To make things yet more complicated, these pressures come from a range of different external sources: for example, a rush to complete fieldwork within a limited timeframe to minimise costs for the funding body, or unexpected delays in participant recruitment that mean that tightly organised fieldwork cannot extend beyond the ethical clearance period granted by the host organisation.
This idea of ‘slow’ working isn’t new (see, for example, Honoré, 2005, or ‘A Call for Slow Scholarship’ by Hartman and Darab, 2012), but it is worth repeating: so much of academic research is subject to the restrictions of budget, outcome, time constraints and metrics that need ticking off that we forget how valuable time and space are for germinating our best ideas. The useful analytical frameworks, or new theories, or vital links we make between seemingly unrelated sets of results are often produced in the scarce time we get to think deeply about concepts or theories at length. It is this type of time which has become most compressed in the contemporary neoliberal university, where there are so many competing demands on the researcher’s time and attention, from emails to admin to marking to service.
In our discussions we came to a consensus that for us, ‘slow’ co-production is about having time to genuinely engage with others in dialogues that cover more ground than simply sharing ideas, although of course ideas come from dialogue so the two concepts aren’t separate. As well as sharing ideas, we can think of slow co-production in terms of humanity and human rights: specifically, reducing the gap between the researcher and the researched, and trying to find common ground in a qualitative methodology that productively disrupts some of the traditional boundaries that we have seen replicated over and over across social sciences and public health research. Therefore, as well as the point that taking more time in the research field can develop more positive, meaningful relations between the different parties in the research, we also want to stress that this in-depth, detailed, sensitive approach to interviewing is a specific form of co-production, and one that we want to pursue further across our DEPTH projects.
So, whilst our article is primarily arguing for the importance of involving patients and participants in qualitative research from the start and throughout the lifespan of a research project, we hope it also offers a small insight into the opportunities enabled by ‘slow’, thorough working between researchers and participants. This ‘slow’ process – scarce as it sometimes feels the opportunity is – can offer a really valuable way into mutually beneficial collaboration.
Hartman Y, Darab, S. (2012) A Call for Slow Scholarship: A Case Study on the Intensification of Academic Life and Its Implications for Pedagogy. Review of Education, Pedagogy, and Cultural Studies, 34(1): 49-60. https://doi.org/10.1080/10714413.2012.643740
Honoré C. (2005) In Praise of Slowness: Challenging the Cult of Speed. New York: HarperCollins.
Now that you’ve been introduced to our new blog, we thought it would make sense to give you a whistle-stop tour of our DEPTH research group here at LSHTM.
We are a group of scholars in the Department of Public Health, Environments and Society at London School of Hygiene & Tropical Medicine who take an interdisciplinary approach to health. We are one of LSHTM’s newest hubs, developed earlier this year as a way to bring together some of our shared work. We use the acronym DEPTH to unify our themes of Dialogue, Evidence, Participation and Translation for Health. We conduct research into different types of dialogue and different people’s participation in health with the aim of increasing equity and improving health worldwide, and amplifying less-heard voices.
Our new website has allowed us to introduce a wider audience to our public health work – you can check it out here. We see it as a space for communication and conversation – not just with academic colleagues, but also in policy debates, in education systems and with the wider public. We also think it is important to show our work to a wide range of audiences, not just specialists, and so we have listed all of our individual or combined efforts on thispage, including summaries of each research paper listed in plain English, with concepts summarised and acronyms explained. You can read about the six Research themesthat underpin DEPTH here. These research themes include our work on patient and public involvement, dialogues about sexual and reproductive health and young people’s experiences of Sickle Cell, and our work with Imperial College London on the ethics of electronic health records.
As for this blog, it functions as a conversation space. It provides a way for us to write about important studies in the field of community involvement, participation and public health. We will talk about our own research, but will also write about current affairs as well as research from elsewhere, when we would like to contribute to debate. We agree that one of the most important things we can do as academics is move beyond our own research specialisms to listen to – and amplify – the perspectives of those who may be less heard. We hope you will find these perspectives as valuable as we do – and key to this is conversation.
Finally, we want to hear from you too! Our blog now has comment space, and we’re very keen to hear your views, thoughts and ideas. You can get also get involved via our Twitter account, and you can with questions, feedback or even your own blog pitch. Finally, look out for upcoming events on this blog page, where we will post details of future talks, meetings and events, as well as commentaries on new publications and policy.
Thanks again for reading and we look forward to sharing more about our work at DEPTH.
We’ve recently developed our own website, including academic publications, updates and links to our research areas including This Sickle Cell Life, sixteen18 and patient & public engagement. To ensure maximum interaction with readers, we have made this WordPress website to allow (indeed, to positively encourage!) reader comments. We feel that this is a crucial part of our work. We see our blog as a space for communication and conversation – not just with academic colleagues, but also in policy debates, in education systems and with the wider public.