1
|
Solorzano-Barrera C, Rodriguez-Patarroyo M, Tórres-Quintero A, Guzman-Tordecilla DN, Franco-Rodriguez AN, Maniar V, Shrestha P, Vecino-Ortiz AI, Pariyo GW, Gibson DG, Ali J. Recruiting hard-to-reach populations via respondent driven sampling for mobile phone surveys in Colombia: a qualitative study. Glob Health Action 2024; 17:2297886. [PMID: 38205794 PMCID: PMC10786427 DOI: 10.1080/16549716.2023.2297886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Uptake of mobile phone surveys (MPS) is increasing in many low- and middle-income countries, particularly within the context of data collection on non-communicable diseases (NCDs) behavioural risk factors. One barrier to collecting representative data through MPS is capturing data from older participants.Respondent driven sampling (RDS) consists of chain-referral strategies where existing study subjects recruit follow-up participants purposively based on predefined eligibility criteria. Adapting RDS strategies to MPS efforts could, theoretically, yield higher rates of participation for that age group. OBJECTIVE To investigate factors that influence the perceived acceptability of a RDS recruitment method for MPS involving people over 45 years of age living in Colombia. METHODS An MPS recruitment strategy deploying RDS techniques was piloted to increase participation of older populations. We conducted a qualitative study that drew from surveys with open and closed-ended items, semi-structured interviews for feedback, and focus group discussions to explore perceptions of the strategy and barriers to its application amongst MPS participants. RESULTS The strategy's success is affected by factors such as cultural adaptation, institutional credibility and public trust, data protection, and challenges with mobile phone technology. These factors are relevant to individuals' willingness to facilitate RDS efforts targeting hard-to-reach people. Recruitment strategies are valuable in part because hard-to-reach populations are often most accessible through their contacts within their social network who can serve as trust liaisons and drive engagement. CONCLUSIONS These findings may inform future studies where similar interventions are being considered to improve access to mobile phone-based data collection amongst hard-to-reach groups.
Collapse
Affiliation(s)
| | | | | | - Deivis Nicolas Guzman-Tordecilla
- Institute of Public Health, Pontificia Universidad Javeriana, Bogota, Colombia
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Vidhi Maniar
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Prakriti Shrestha
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrés I Vecino-Ortiz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - George W Pariyo
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
2
|
Tackett S, Ng CJ, Sugarman J, Daniel EGS, Gopalan N, Tivyashinee T, Kamarulzaman A, Ali J. Defining Malaysia's health research ethics system through a stakeholder driven approach. Dev World Bioeth 2024; 24:74-83. [PMID: 36861660 PMCID: PMC10474241 DOI: 10.1111/dewb.12396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 03/03/2023]
Abstract
The need to understand the systems that support ethical health research has long been recognized, but there are limited descriptions of actual health research ethics (HRE) systems. Using participatory network mapping methods, we empirically defined Malaysia's HRE system. 13 Malaysian stakeholders identified 4 overarching and 25 specific HRE system functions and 35 actors internal and 3 external to the Malaysian HRE system responsible for those functions. Functions requiring the most attention were: advising on legislation related to HRE; optimizing research value to society; and defining standards for HRE oversight. Internal actors with the greatest potential for more influence were: the national network of research ethics committees; non-institution-based research ethics committees; and research participants. The World Health Organization, an external actor, had the largest untapped potential for influence overall. In summary, this stakeholder-driven process identified HRE system functions and actors that could be targeted to increase HRE system capacity.
Collapse
|
3
|
Shaw J, Ali J, Atuire CA, Cheah PY, Español AG, Gichoya JW, Hunt A, Jjingo D, Littler K, Paolotti D, Vayena E. Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research. BMC Med Ethics 2024; 25:46. [PMID: 38637857 PMCID: PMC11025232 DOI: 10.1186/s12910-024-01044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/01/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. METHODS The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was "Ethics of AI in Global Health Research". The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022. RESULTS We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships. CONCLUSIONS The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.
Collapse
Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Caesar A Atuire
- Department of Philosophy and Classics, University of Ghana, Legon-Accra, Ghana
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Judy Wawira Gichoya
- Department of Radiology and Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Adrienne Hunt
- Health Ethics & Governance Unit, Research for Health Department, Science Division, World Health Organization, Geneva, Switzerland
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics and Data Intensive Science, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Katherine Littler
- Health Ethics & Governance Unit, Research for Health Department, Science Division, World Health Organization, Geneva, Switzerland
| | | | - Effy Vayena
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| |
Collapse
|
4
|
Ferretti A, Adjei KK, Ali J, Atuire C, Ayuk BT, Banougnin BH, Cengiz N, Gichoya J, Jjingo D, Juma DO, Kotze W, Krubiner C, Littler K, McCradden MD, Moodley K, Naidoo M, Nair G, Obeng-Kyereh K, Oliver K, Ralefala D, Toska E, Wekesah FM, Wright J, Vayena E. Digital tools for youth health promotion: principles, policies and practices in sub-Saharan Africa. Health Promot Int 2024; 39:daae030. [PMID: 38558241 PMCID: PMC10983781 DOI: 10.1093/heapro/daae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Although digital health promotion (DHP) technologies for young people are increasingly available in low- and middle-income countries (LMICs), there has been insufficient research investigating whether existing ethical and policy frameworks are adequate to address the challenges and promote the technological opportunities in these settings. In an effort to fill this gap and as part of a larger research project, in November 2022, we conducted a workshop in Cape Town, South Africa, entitled 'Unlocking the Potential of Digital Health Promotion for Young People in Low- and Middle-Income Countries'. The workshop brought together 25 experts from the areas of digital health ethics, youth health and engagement, health policy and promotion and technology development, predominantly from sub-Saharan Africa (SSA), to explore their views on the ethics and governance and potential policy pathways of DHP for young people in LMICs. Using the World Café method, participants contributed their views on (i) the advantages and barriers associated with DHP for youth in LMICs, (ii) the availability and relevance of ethical and regulatory frameworks for DHP and (iii) the translation of ethical principles into policies and implementation practices required by these policies, within the context of SSA. Our thematic analysis of the ensuing discussion revealed a willingness to foster such technologies if they prove safe, do not exacerbate inequalities, put youth at the center and are subject to appropriate oversight. In addition, our work has led to the potential translation of fundamental ethical principles into the form of a policy roadmap for ethically aligned DHP for youth in SSA.
Collapse
Affiliation(s)
- Agata Ferretti
- Health Ethics and Policy Lab, ETH Zurich, Hottingerstrasse 10, 8092 Zurich, Switzerland
| | - Kwame K Adjei
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Ghana
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD 21205, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Caesar Atuire
- Department of Philosophy and Classics, University of Ghana, MR26+9PV, W.E.B. Dubois Road, Accra, Ghana
- Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, OX3 7BN, UK
| | - Betrand Tambe Ayuk
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, 574W+49W, Buea, Cameroon
| | - Boladé Hamed Banougnin
- United Nations Population Fund, West and Central Africa Regional Office, PFQM+RVF, Route des Almadies, Dakar, Senegal
- Centre for Social Science Research, University of Cape Town, 12 University Avenue South, Rondebosch, Cape Town 7700, South Africa
| | - Nezerith Cengiz
- Department of Medicine, Faculty of Medicine and Health Sciences, Division for Medical Ethics and Law, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Judy Gichoya
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322, USA
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics and Data Intensive Sciences, Infectious Diseases Institute, Makerere University, 8HMC+PF5, Kampala, Uganda
| | | | - Wiaan Kotze
- Faculty of Medicine and Health Science, Stellenbosch University, Francie Van Zijl Drive, Parow, Cape Town 7505, South Africa
| | | | - Katherine Littler
- Health Ethics & Governance Unit, Research for Health Department, Science Division, WHO, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Melissa D McCradden
- Department of Bioethics, Genetics & Genome Biology, SickKids Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Keymanthri Moodley
- Department of Medicine, Faculty of Medicine and Health Sciences, Division for Medical Ethics and Law, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Meshandren Naidoo
- Howard College, School of Law, University of KwaZulu-Natal, King George V Avenue, Durban 4041, South Africa
| | - Gonasagrie Nair
- Desmond Tutu Health Foundation, 3 Woodlands Road, Woodstock, Cape Town 7915, South Africa
| | - Kingsley Obeng-Kyereh
- Children and Youth in Broadcasting—Curious Minds, 3 Damba Close, Chaban-Sakaman, Accra, Ghana
| | - Kedebone Oliver
- Genesis Analytics, Health Practice Area, 50 6th Road, Hyde Park, Johannesburg 2196, South Africa
| | - Dimpho Ralefala
- Office of Research and Development, University of Botswana, 4775 Notwane Road, Gaborone, Botswana
| | - Elona Toska
- Faculty of Humanities, Centre for Social Science Research, University of Cape Town, 12 University Avenue, Rondebosch, Cape Town 7700, South Africa
| | - Frederick M Wekesah
- African Population and Health Research Center, APHRC Headquarters, Kitisuru, Nairobi, Kenya
| | - Jonty Wright
- Faculty of Medicine and Health Science, Stellenbosch University, Francie Van Zijl Drive, Parow, Cape Town 7505, South Africa
| | - Effy Vayena
- Health Ethics and Policy Lab, ETH Zurich, Hottingerstrasse 10, 8092 Zurich, Switzerland
| |
Collapse
|
5
|
Ali J, Thompson M, Mackenzie C. Assessing the frequency and types of errors involved in the use of a modified intravenous N-acetylcysteine protocol for acetaminophen overdose. CAN J EMERG MED 2024; 26:174-178. [PMID: 38340270 DOI: 10.1007/s43678-023-00641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Acetaminophen overdose is a leading cause of acute liver failure in developing countries. N-acetylcysteine (NAC) is a highly effective antidote for acetaminophen hepatotoxicity, typically initiated in the emergency department. Due to a known high rate of errors with the standard three-bag IV NAC protocol, in 2019, the Ontario Poison Center changed to a modified 3% IV NAC one-bag protocol. This study was undertaken to determine the frequency and types of errors associated with the use of this protocol. METHODS Data were gathered via chart review of Ontario Poison Centre electronic medical record cases identified as receiving IV NAC for acetaminophen overdose between August 1 and September 30, 2022. 218 total charts were identified, and 188 were deemed eligible based on inclusion and exclusion criteria. RESULTS Errors were identified in 25% of charts, consisting of dosing errors in 11.7%, stopping errors in 9.0%, initiation errors in 3.7%, and interruptions in therapy in 3.2%. Dosing errors were the most common type of error (44.4%), with overdoses occurring three times more than underdoses. Errors were identified at 39% of geographic locations in the charts reviewed, with similar frequency in Ontario, Manitoba, and Nunavut. Clinical outcomes were similar in charts with and without errors. INTERPRETATION The rate of errors identified with this 3% IV NAC one-bag protocol is lower than reported for the standard three-bag protocol, but remains high due to dosing errors. Previously reported issues with prolonged interruptions in therapy with the standard three-bag protocol were low with the current 3% one-bag protocol. Although severe outcomes are rare, IV NAC overdose can be fatal. Identifying local factors in emergency departments that can contribute to administration errors (i.e., dose calculation, pump programming issues) can enhance the safety of this important antidote.
Collapse
Affiliation(s)
- J Ali
- Department of Medicine, Western University, London, ON, Canada
| | - M Thompson
- Ontario Poison Centre, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
- Division of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Connie Mackenzie
- Ontario Poison Centre, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada.
- Divisions of Clinical Pharmacology and Toxicology/Respirology, Western University, London, ON, Canada.
| |
Collapse
|
6
|
Al Kibria GM, Kagoro F, Pariyo G, Ali J, Hassan F, Kilambo JW, Petro I, Maniar V, Kaufman MR, Vecino-Ortiz A, Ahmed S, Masanja H, Gibson DG. A nationwide mobile phone survey for tobacco use in Tanzania: Sample quality and representativeness compared to a household survey. Prev Med Rep 2024; 38:102609. [PMID: 38375185 PMCID: PMC10874872 DOI: 10.1016/j.pmedr.2024.102609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/21/2024] Open
Abstract
We investigated the feasibility of an interactive voice response (IVR) survey in Tanzania and compared its prevalence estimates for tobacco use to the estimates of the 'Global Adult Tobacco Survey (GATS) 2018'. IVR participants were enrolled by random digit dialing. Quota sampling was employed to achieve the required sample sizes of age-sex strata: sex (male/female) and age (18-29-, 30-44-, 45-59-, and ≥60-year-olds). GATS was a nationally representative survey and used a multistage stratified cluster sampling design. The IVR sample's weights were generated using the inverse proportional weighting (IPW) method with a logit model and the standard age-sex distribution of Tanzania. The IVR and GATS had 2362 and 4555 participants, respectively. Compared to GATS, the unweighted IVR sample had a higher proportion of males (58.7 % vs. 43.2 %), educated people (secondary/above education: 43.3 % vs. 21.1 %), and urban residents (56.5 % vs. 40 %). The weighted prevalence (95 % confidence interval (CI)) of current smoking was 4.99 % (4.11-6.04), 5.22 % (4.36-6.24), and 7.36 % (6.51-8.31) among IVR (IPW), IVR (age-sex standard), and GATS samples, respectively; the weighted prevalence (95 % CI) of smokeless tobacco use was similar: 3.54 % (2.73-4.57), 3.58 % (2.80-4.56), and 2.43 % (1.98-2.98), respectively. Most differences in point estimates for tobacco indicators were small (<2%). Overall, the odds of tobacco smoking indicators were lower in IVR than in GATS; however, the odds of smokeless tobacco use were reversed. Although we found under-/over-estimation of the prevalence of tobacco use in IVR than GATS, the estimates were close. Further research is required to increase the representativeness of IVR.
Collapse
Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Frank Kagoro
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Center for Optimising Antimalarial Therapy, University of Cape Town, Cape Town, South Africa
- The Global Health Network, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - George Pariyo
- Serum Africa Medical Research Institute, Kampala, Uganda
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, United States
| | | | | | - Irene Petro
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Vidhi Maniar
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Michelle R. Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Andres Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Saifuddin Ahmed
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | | | - Dustin G. Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| |
Collapse
|
7
|
Modlin C, Sugarman J, Chongwe G, Kass N, Nazziwa W, Tegli J, Shrestha P, Ali J. Towards achieving transnational research partnership equity: lessons from implementing adaptive platform trials in low- and middle-income countries. Wellcome Open Res 2023; 8:120. [PMID: 38089903 PMCID: PMC10714106 DOI: 10.12688/wellcomeopenres.18915.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 02/01/2024] Open
Abstract
Background Use of adaptive clinical trials, particularly adaptive platform trials, has grown exponentially in response to the coronavirus disease (COVID-19) pandemic. Implementation of these trials in low- and middle-income countries (LMICs) has been fostered through the formation or modification of transnational research partnerships, typically between research groups from LMICs and high-income countries (HICs). While these partnerships are important to promote collaboration and overcome the structural and economic disadvantages faced by LMIC health researchers, it is critical to focus attention on the multiple dimensions of partnership equity. Methods Based on informal literature reviews and a meeting with leaders of one of the multinational COVID-19 adaptive platform trials, we describe some important considerations about research partnership equity in this context. Results We organize these considerations into eight thematic categories: 1) epistemic structures, 2) funding, 3) ethics oversight, 4) regulatory oversight, 5) leadership, 6) post-trial access to interventions, data, and specimens, 7) knowledge translation and dissemination, and 8) research capacity strengthening and maintenance. Within each category we review normative claims that support its relevance to research partnership equity followed by discussion of how adaptive platform trials highlight new dimensions, considerations, or challenges. Conclusion In aggregate, these observations provide insight into procedural and substantive equity-building measures within transnational global health research partnerships more broadly.
Collapse
Affiliation(s)
- Chelsea Modlin
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
| | - Jeremy Sugarman
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Gershom Chongwe
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Nancy Kass
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Winfred Nazziwa
- Uganda National Council for Science and Technology, Kampala, Uganda
| | - Jemee Tegli
- Family Health International Clinical/Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Prakriti Shrestha
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Joseph Ali
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| |
Collapse
|
8
|
Rhon DI, Davis AF, Ali J, Brandt C, Burns A, Lucio W, Vining R, Young-McCaughan S. Ambiguity in care delivery terminology: implications that affect pragmatic clinical trials using non-pharmacological interventions. BMJ Evid Based Med 2023:bmjebm-2023-112547. [PMID: 37989537 DOI: 10.1136/bmjebm-2023-112547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Daniel I Rhon
- Rehabilitation Medicine, US Army Brooke Army Medical Center, Fort Sam Houston, Texas, USA
- Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Alison F Davis
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Joseph Ali
- Johns Hopkins University Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Cynthia Brandt
- Section of Biomedical Informatics and Data Science, School of Medicine, Yale University, New Haven, Connecticut, USA
- VA Connecticut Healthcare, West Haven, Connecticut, USA
| | - Amy Burns
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- VA Connecticut Healthcare, West Haven, Connecticut, USA
| | - Whitley Lucio
- Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Geneva Foundation, Tacoma, Washington, USA
| | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa, USA
| | | |
Collapse
|
9
|
Suwalowska H, Ali J, Rangel de Almeida J, Fonseca SA, Heathfield LJ, Keyes CA, Lukande R, Martin LJ, Reid KM, Vaswani V, Wasti H, Wilson RO, Parker M, Kingori P. "The Nobodies": unidentified dead bodies-a global health crisis requiring urgent attention. Lancet Glob Health 2023; 11:e1691-e1693. [PMID: 37774720 DOI: 10.1016/s2214-109x(23)00420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Halina Suwalowska
- Ethox Centre, Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford OX3 7LF, UK.
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MA, USA
| | | | - Stephen Antonio Fonseca
- International Committee of the Red Cross, African Centre for Medicolegal Systems, Pretoria, South Africa
| | - Laura Jane Heathfield
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Craig Adam Keyes
- Department of Forensic Medicine and Pathology, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Robert Lukande
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lorna J Martin
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kate Megan Reid
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Vina Vaswani
- Centre for Ethics, Department of Forensic Medicine & Toxicology, Yenepoya University, Mangalore, India
| | - Harihar Wasti
- Forensic Medicine Department, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Regis O Wilson
- School of Social Sciences, College of Humanities, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Michael Parker
- Ethox Centre, Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford OX3 7LF, UK
| | - Patricia Kingori
- Ethox Centre, Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford OX3 7LF, UK
| |
Collapse
|
10
|
Alhelou Y, Hamdan M, Razali N, Adenan N, Ali J. Novel image analyser-assisted morphometric methodology offer unique opportunity for selection of embryos with potential for implantation. BMC Pregnancy Childbirth 2023; 23:698. [PMID: 37770819 PMCID: PMC10538025 DOI: 10.1186/s12884-023-06025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/23/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Previous studies looked into the connections between pregnancy and the Zona Pellucida (ZP) thickness and Zona Pellucida Thickness Variation (ZPTV), as well as the embryo's radius, circumference, perimeter and global symmetry. However, no research has linked embryo implantation and pregnancy to the percentage of ZP thinning, the reduction in ooplasm volume, and the increase in perivitelline space (PVS) volume. Our objective is to correlate the percentage of ZP thinning, the percentage of ooplasm volume shrinkage and the percentage of PVS increase to the implantation. These data will be used for embryo selection as well as it can be put into a software that will assist embryo selection. MATERIALS AND METHODS Retrospective study included 281 patients, all of them had 2 embryos transferred, 149 patients got pregnant with two gestation sacs and 132 patients did not get pregnant. All of the transferred embryos had the ZP thickness measured several times from time of ICSI till Embryo Transfer (ET), the ooplasm volume was calculated from time of ICSI till two Pronuclei (2PN) fading and the PVS was calculated from the ICSI time till the 2PN fading. RESULTS The first characteristic is the change in the average ZP thickness that decreased by 32.7% + 5.3% at 70 h for the implanted embryos (Group 1) versus 23.6% + 4.8% for non-implanted embryos (Group 2) p = 0.000. The second characteristic is the average reduction in the volume of the ooplasm which is 20.5% + 4.3% in Group 1 versus 15.1% + 5.2% in Group 2, p = 0.000. The third characteristic is the increase in the volume of the PVS which was 38.1% + 7.6% in Group 1 versus 31.6% + 9.7% in Group 2 p = 0.000. CONCLUSION The implanted embryos showed higher percent of ZP thinning, higher percent of ooplasm reduction and higher percent of PVS increase.
Collapse
Affiliation(s)
- Y Alhelou
- FAKIH IVF, Sh Haza Bin Zayed st, Abu Dhabi, United Arab Emirates.
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - M Hamdan
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - N Razali
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nam Adenan
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - J Ali
- Department of Obstetrics and Gynaecology, Universiti Malaya, Kuala Lumpur, Malaysia
- IVF Department, Maternity and Children Hospital, Dammam, Saudi Arabia
| |
Collapse
|
11
|
Chongwe G, Ali J, Kaye DK, Michelo C, Kass N. Ethics of Adaptive Designs for Randomized Controlled Trials. Ethics Hum Res 2023; 45:2-14. [PMID: 37777976 PMCID: PMC10739783 DOI: 10.1002/eahr.500178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Over recent decades, adaptive trial designs have been used more and more often for clinical trials, including randomized controlled trials (RCTs). This rise in the use of adaptive RCTs has been accompanied by debates about whether such trials offer ethical and methodological advantages over traditional, fixed RCTs. This study examined how experts on clinical trial methods and ethics believe that adaptive RCTs, compared to fixed ones, affect the ethical character of clinical research. We conducted in-depth interviews with 17 researchers from bioethics, epidemiology, biostatistics, and/or medical backgrounds. While about half believed that adaptive trials are more complex and may thus threaten autonomy, these respondents also expressed that this challenge is not insurmountable. Most respondents expressed that efficiency and potential for participant benefit were the main justifications for adaptive trials. There was tension about whether adaptive randomization in response to increasing information disrupts clinical equipoise, with some respondents insisting that uncertainty still exists and therefore clinical equipoise is not disrupted. These findings suggest that further discussion is needed to increase the awareness and utility of these study designs.
Collapse
Affiliation(s)
- Gershom Chongwe
- School of Public Health, University of Zambia, Department
of Epidemiology and Biostatistics, Box 50110, Lusaka, Zambia
- Johns Hopkins University, Berman Institute of Bioethics,
1809 Ashland Avenue, Baltimore, MD, 21205, USA
- Tropical Diseases Research Centre, Box 71769, Ndola,
Zambia
| | - Joseph Ali
- Johns Hopkins University, Berman Institute of Bioethics,
1809 Ashland Avenue, Baltimore, MD, 21205, USA
| | - Daniel K. Kaye
- College of Health Sciences, Department of Obstetrics and
Gynaecology, Makerere University
| | - Charles Michelo
- School of Public Health, University of Zambia, Department
of Epidemiology and Biostatistics, Box 50110, Lusaka, Zambia
| | - Nancy Kass
- Johns Hopkins University, Berman Institute of Bioethics,
1809 Ashland Avenue, Baltimore, MD, 21205, USA
| |
Collapse
|
12
|
Kibria GMA, Ahmed S, Khan IA, Fernández-Niño JA, Vecino-Ortiz A, Ali J, Pariyo G, Kaufman M, Sen A, Basu S, Gibson D. Developing digital tools for health surveys in low- and middle-income countries: Comparing findings of two mobile phone surveys with a nationally representative in-person survey in Bangladesh. PLOS Glob Public Health 2023; 3:e0002053. [PMID: 37498841 PMCID: PMC10374008 DOI: 10.1371/journal.pgph.0002053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Non-communicable disease (NCD) risk factor data from low- and middle-income countries (LMICs) are inadequate, mostly due to the cost and burden of collecting in-person population-level estimates. High-income countries regularly use phone-based surveys, and with increasing mobile phone subscription in developing countries, mobile phone surveys (MPS) could complement in-person surveys in LMICs. We compared the representativeness and prevalence estimates of two MPS (i.e., interactive voice response (IVR) and computer-assisted telephone interview (CATI)) with a nationally representative household survey in Bangladesh-the STEPwise approach to NCD risk factor surveillance (STEPs) 2018. This cross-sectional study included 18-69-year-old respondents. CATI and IVR recruitments were done by random digit dialing, while STEPs used multistage cluster sampling design. The prevalence of NCD risk factors related to tobacco, alcohol, diet, and hypertension was reported and compared by prevalence differences (PD) and prevalence ratios (PR). We included 2355 (57% males), 1942 (62% males), and 8185 (47% males) respondents in the CATI, IVR, and STEPs, respectively. CATI (28%) and IVR (52%) had a higher proportion of secondary/above-educated people than STEPs (13%). Most prevalence estimates differed by survey mode; however, CATI estimates were closer to STEPs than IVR. For instance, in CATI, IVR, and STEPs, respectively, the prevalence was 21.4%, 17.9%, and 23.5% for current smoking; and 1.6%, 2.2%, and 1.5% for alcohol drinking in past month. Compared to STEPs, the PD ranged from '-56.6% to 0.4%' in CATI and '-41.0% to 8.4%' in IVR; the PR ranged from '0.3 to 1.1' in CATI and '0.3 to 1.6' in IVR. There were some differences and some similarities in NCD indicators produced by MPS and STEPs with differences likely due to differences in socioeconomic characteristics between survey participants.
Collapse
Affiliation(s)
- Gulam Muhammaed Al Kibria
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Iqbal Ansary Khan
- Institute of Epidemiology Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh
| | - Julián A Fernández-Niño
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Andres Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States of America
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Michelle Kaufman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Aninda Sen
- Institute of Epidemiology Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh
| | - Sunada Basu
- Institute of Epidemiology Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh
| | - Dustin Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| |
Collapse
|
13
|
Wright K, Ali J, Davies A, Glasziou P, Gobat N, Kuchenmüller T, Littler K, Modlin C, Pascoe LA, Reis A, Singh JA. Ethical priorities for international collaborative adaptive platform trials for public health emergencies. BMJ Glob Health 2023; 8:e012930. [PMID: 37524503 PMCID: PMC10391826 DOI: 10.1136/bmjgh-2023-012930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alun Davies
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Nina Gobat
- Community Readiness and Resilience Unit, World Health Organization, Geneva, Switzerland
| | - Tanja Kuchenmüller
- Evidence to Policy and Impact Unit, World Health Organization, Geneva, Switzerland
| | | | - Chelsea Modlin
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lee-Anne Pascoe
- Health Ethics and Governance Unit, WHO, Geneva, GE, Switzerland
| | - Andreas Reis
- Health Ethics and Governance Unit, WHO, Geneva, GE, Switzerland
| | - Jerome Amir Singh
- Howard College School of Law, University of KwaZulu Natal, Durban, South Africa
| |
Collapse
|
14
|
Guzman-Tordecilla DN, Vecino-Ortiz AI, Torres-Quintero A, Solorzano-Barrera C, Ali J, Peñaloza-Quintero RE, Ahmed S, Pariyo GW, Maniar V, Gibson DG. Examination of the demographic representativeness of a cross-sectional mobile phone survey in collecting health data in Colombia using random digit dialling. BMJ Open 2023; 13:e073647. [PMID: 37328185 PMCID: PMC10277114 DOI: 10.1136/bmjopen-2023-073647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVES As mobile phone ownership becomes more widespread in low-income and middle-income countries, mobile phone surveys (MPSs) present an opportunity to collect data on health more cost-effectively. However, selectivity and coverage biases in MPS are concerns, and there is limited information about the population-level representativeness of these surveys compared with household surveys. This study aims at comparing the sociodemographic characteristics of the respondents of an MPS on non-communicable disease risk factors to a household survey in Colombia. DESIGN Cross-sectional study. We used a random digit dialling method to select the samples for calling mobile phone numbers. The survey was conducted using two modalities: computer-assisted telephone interviews (CATIs) and interactive voice response (IVR). The participants were assigned randomly to one of the survey modalities based on a targeted sampling quota stratified by age and sex. The Quality-of-Life Survey (ECV), a nationally representative survey conducted in the same year of the MPS, was used as a reference to compare the sample distributions by sociodemographic characteristics of the MPS data. Univariate and bivariate analyses were performed to evaluate the population representativeness between the ECV and the MPSs. SETTING The study was conducted in Colombia in 2021. PARTICIPANTS Population at least 18 years old with a mobile phone. RESULTS We completed 1926 and 2983 interviews for CATI and IVR, respectively. We found that the MPS data have a similar (within 10% points) age-sex data distribution compared with the ECV dataset for some subpopulations, mainly for young populations, people with none/primary and secondary education levels, and people who live in urban and rural areas. CONCLUSIONS This study shows that MPS could collect similar data to household surveys in terms of age, sex, high school education level and geographical area for some population categories. Strategies are needed to improve representativeness of the under-represented groups.
Collapse
Affiliation(s)
- Deivis Nicolas Guzman-Tordecilla
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute of Public Health, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Andres I Vecino-Ortiz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Saifuddin Ahmed
- Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - George W Pariyo
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vidhi Maniar
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
15
|
Zulu VC, Syakalima M, Ali J. Ethical dimensions of zoonotic disease research: Perspectives of traditional livestock keepers in Zambia. Wellcome Open Res 2023; 7:201. [PMID: 37496727 PMCID: PMC10366554 DOI: 10.12688/wellcomeopenres.17962.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/28/2023] Open
Abstract
Background: With the increase in zoonotic disease research using livestock belonging to traditional livestock keepers (LKs) as research subjects, careful attention to both animal and livestock keeper interests is critically important in Zambia and other similar contexts. Methods: The study aimed to explore ethics-related challenges during zoonotic disease research among LKs where their livestock are included as research subjects. The study was implemented in the Southern province of Zambia in July 2020. Three focus group discussions (FGDs) involving 30 adult male LKs living in livestock-wildlife interface areas where zoonotic diseases are likely to occur, were carried out. The FGDs were done in the local language and audio recorded. Thematic analysis was done using field notes and translated and transcribed recorded interviews. Results: The study found that trust between the researchers and LKs when their livestock are used as research subjects was very cardinal and depended on the continual presence of the local veterinary assistant (VA) during the conduct of research. Conclusions: The LKs could be considered a vulnerable population when their livestock were used as research subjects as, being resource poor, they were looking to researchers to provide benefits yet not fully understanding the research, and thus did not worry so much about consent procedures, bringing into question the validity of the oral consent obtained. The study also found that opportunities to strengthen trust and enhance the research experience could be exploited by researchers conducting research that is locally relevant and desired, being aware of procedural preferences for entering into livestock keeping communities, adequate disclosure of research procedures, respecting conventions and traditional cultural beliefs, and returning results of research. The findings of this study can be used by both researchers as they carry-out zoonotic disease research and by Research Ethics Committees.
Collapse
Affiliation(s)
- Victor Chisha Zulu
- Clinical Studies, School of Veterinary Medicine; University of Zambia, P.O. Box 32379, Lusaka, Lusaka, 10101, Zambia
| | - Michelo Syakalima
- Disease Control, School of Veterinary Medicine, University of Zambia, P.O Box 32379, Lusaka, Lusaka, 10101, Zambia
| | - Joseph Ali
- International Health, Bloomberg School of Public Health and Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, 21205, USA
| |
Collapse
|
16
|
Labrique A, Nagarajan M, Kibria GMA, Vecino-Ortiz A, Pariyo GW, Ali J, Kaufman MR, Gibson D. Improving success of non-communicable diseases mobile phone surveys: Results of two randomized trials testing interviewer gender and message valence in Bangladesh and Uganda. PLoS One 2023; 18:e0285155. [PMID: 37224125 DOI: 10.1371/journal.pone.0285155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Although interactive voice response (IVR) is a promising mobile phone survey (MPS) method for public health data collection in low- and middle-income countries (LMICs), participation rates for this method remain lower than traditional methods. This study tested whether using different introductory messages increases the participation rates of IVR surveys in two LMICs, Bangladesh and Uganda. METHODS We conducted two randomized, controlled micro-trials using fully-automated random digit dialing to test the impact of (1) the gender of the speaker recording the survey (i.e., survey voice); and (2) the valence of the invitation to participate in the survey (i.e., survey introduction) on response and cooperation rates. Participants indicated their consent by using the keypad of cellphones. Four study arms were compared: (1) male and informational (MI); (2) female and information (FI); (3) male and motivational (MM); and (4) female and motivational (FM). RESULTS Bangladesh and Uganda had 1705 and 1732 complete surveys, respectively. In both countries, a majority of the respondents were males, young adults (i.e., 18-29-year-olds), urban residents, and had O-level/above education level. In Bangladesh, the contact rate was higher in FI (48.9%), MM (50.0%), and FM (55.2%) groups than in MI (43.0%); the response rate was higher in FI (32.3%) and FM (33.1%) but not in MM (27.2%) and MI (27.1%). Some differences in cooperation and refusal rates were also observed. In Uganda, MM (65.4%) and FM (67.9%) had higher contact rates than MI (60.8%). The response rate was only higher in MI (52.5%) compared to MI (45.9%). Refusal and cooperation rates were similar. In Bangladesh, after pooling by introductions, female arms had higher contact (52.1% vs 46.5%), response (32.7% vs 27.1%), and cooperation (47.8% vs 40.4%) rates than male arms. Pooling by gender showed higher contact (52.3% vs 45.6%) and refusal (22.5% vs 16.3%) rates but lower cooperation rate (40.0% vs 48.2%) in motivational arms than informational arms. In Uganda, pooling intros did not show any difference in survey rates by gender; however, pooling by intros showed higher contact (66.5% vs 61.5%) and response (50.0% vs 45.2%) rates in motivational arms than informational arms. CONCLUSION Overall, we found higher survey rates among female voice and motivational introduction arms compared to male voice and informational introduction arm in Bangladesh. However, Uganda had higher rates for motivational intro arms only compared to informational arms. Gender and valence must be considered for successful IVR surveys. TRIAL REGISTRATION Name of the registry: ClinicalTrials.gov. Trial registration number: NCT03772431. Date of registration: 12/11/2018, Retrospectively Registered. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03772431?term=03772431&cond=Non-Communicable+Disease&draw=2&rank=1. Protocol Availability: https://www.researchprotocols.org/2017/5/e81.
Collapse
Affiliation(s)
- Alain Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Madhuram Nagarajan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | - Andres Vecino-Ortiz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - George W Pariyo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Michelle R Kaufman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Dustin Gibson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| |
Collapse
|
17
|
Modlin CE, Kankaka EN, Chang LW, Sewankambo NK, Ali J. Exploring HIV/AIDS investigator perceptions of equity within research partnerships between low-and middle-income and high-income countries: a pilot survey. Health Res Policy Syst 2023; 21:32. [PMID: 37127604 PMCID: PMC10152781 DOI: 10.1186/s12961-023-00977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/27/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Recommendations for research partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs) stress the importance of equity within the collaboration. However, there is limited knowledge of the practical challenges and successes involved in establishing equitable research practices. This study describes the results of a pilot survey assessing key issues on LMIC/HIC partnership equity within HIV/AIDS research collaborations and compares perspectives of these issues between LMIC- and HIC-based investigators. METHODS Survey participants were selected using clustered, random sampling and snowball sampling. Responses were compared between LMIC and HIC respondents using standard descriptive statistics. Qualitative respondent feedback was analyzed using a combination of exploratory and confirmatory thematic analysis. RESULTS The majority of categories within four themes (research interests and resources; leadership, trust, and communication; cultural and ethical competence; representation and benefits) demonstrated relative consensus between LMIC and HIC respondents except for 'lack of trust within the partnership' which was rated as a more pronounced challenge by LMIC respondents. However, subcategories within some of the themes had significant differences between respondent groups including: equitable setting of the research agenda, compromise within a partnership, the role of regulatory bodies in monitoring partnerships for equity, and post-study access to research technology. CONCLUSIONS These efforts serve as a proof-of-concept survey characterizing contemporary issues around international research partnership equity. The frequency and severity of specific equity issues can be assessed, highlighting similarities versus differences in experiences between LMIC and HIC partners as potential targets for further discussion and evaluation.
Collapse
Affiliation(s)
- Chelsea E Modlin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD, USA.
| | - Edward Nelson Kankaka
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Rakai Health Sciences Program, Rakai, Uganda
| | - Larry W Chang
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nelson K Sewankambo
- Rakai Health Sciences Program, Rakai, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ali
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
18
|
Tackett S, Jenn Ng C, Sugarman J, Daniel EGS, Gopalan N, Tivyashinee, Kamarulzaman A, Ali J. A Competency Framework for Health Research Ethics Educational Programs: Results from a Stakeholder-Driven Mixed-Method Process. Ethics Hum Res 2023; 45:29-39. [PMID: 37167475 PMCID: PMC10228593 DOI: 10.1002/eahr.500166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Educational programs are integral to building health research ethics (HRE) capacity, but no outcomes framework exists to guide them. We empirically developed a competency framework for health research ethics education-the Framework for Research Ethics Studies Competencies and Outcomes (FRESCO)-using mixed methods, including group concept mapping and a survey of international experts. FRESCO includes seven competency domains: (1) Foundational Knowledge; (2) Laws, Regulations, Guidelines, and Policies for Research Oversight; (3) Ethical-Issue Identification, Analysis, and Resolution; (4) Engagement, Communication, and Advocacy; (5) Lifelong Learning, Education, Research, and Scholarship; (6) Coordination, Stewardship, and Responsiveness in HRE Systems; and (7) Impartiality, Honesty, and Responsibility. These domains are detailed in 27 subdomains. Survey respondents rated FRESCO's relevance to HRE highly. FRESCO can be adapted and implemented in educational programs to refine recruitment and selection processes, educational and assessment methods, and performance measures to ensure that HRE educational programs have their intended effects.
Collapse
Affiliation(s)
- Sean Tackett
- Associate professor of medicine at the Johns Hopkins University School of Medicine and the international medical education director in the Division of General Internal Medicine at Johns Hopkins Bayview Medical Center
| | - Chirk Jenn Ng
- Clinical professor of family medicine at Duke-NUS Medical School and an Honorary Professor at the Faculty of Medicine at the Universiti Malaya
| | - Jeremy Sugarman
- Harvey M. Meyerhoff Professor of Bioethics and Medicine at the Berman Institute of Bioethics and the Department of Medicine at the Johns Hopkins University
| | | | - Nishakanthi Gopalan
- Senior lecturer at the Medical Humanities and Ethics Unit at the Faculty of Medicine at Universiti Malaya and the program coordinator for the Master of Health Research Ethics program
| | - Tivyashinee
- Medical graduate from Perdana University-Royal College of Surgeons in Ireland and a manager for the Master of Health Research Ethics program
| | - Adeeba Kamarulzaman
- Professor of medicine and infectious diseases at the University Malaya Medical Centre and the director of the Centre of Excellence in Research on AIDS at the University of Malaya
| | - Joseph Ali
- Associate professor of international health at the Johns Hopkins Bloomberg School of Public Health and a member of the core faculty and the associate director for Global Programs at Johns Hopkins Berman Institute of Bioethics
| |
Collapse
|
19
|
Pariyo G, Meghani A, Gibson D, Ali J, Labrique A, Khan IA, Kibria GMA, Masanja H, Hyder AA, Ahmed S. Effect of the Data Collection Method on Mobile Phone Survey Participation in Bangladesh and Tanzania: Secondary Analyses of a Randomized Crossover Trial. JMIR Form Res 2023; 7:e38774. [PMID: 37079373 PMCID: PMC10160933 DOI: 10.2196/38774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Mobile phone surveys provide a novel opportunity to collect population-based estimates of public health risk factors; however, nonresponse and low participation challenge the goal of collecting unbiased survey estimates. OBJECTIVE This study compares the performance of computer-assisted telephone interview (CATI) and interactive voice response (IVR) survey modalities for noncommunicable disease risk factors in Bangladesh and Tanzania. METHODS This study used secondary data from a randomized crossover trial. Between June 2017 and August 2017, study participants were identified using the random digit dialing method. Mobile phone numbers were randomly allocated to either a CATI or IVR survey. The analysis examined survey completion, contact, response, refusal, and cooperation rates of those who received the CATI and IVR surveys. Differences in survey outcomes between modes were assessed using multilevel, multivariable logistic regression models to adjust for confounding covariates. These analyses were adjusted for clustering effects by mobile network providers. RESULTS For the CATI surveys, 7044 and 4399 phone numbers were contacted in Bangladesh and Tanzania, respectively, and 60,863 and 51,685 phone numbers, respectively, were contacted for the IVR survey. The total numbers of completed interviews in Bangladesh were 949 for CATI and 1026 for IVR and in Tanzania were 447 for CATI and 801 for IVR. Response rates for CATI were 5.4% (377/7044) in Bangladesh and 8.6% (376/4391) in Tanzania; response rates for IVR were 0.8% (498/60,377) in Bangladesh and 1.1% (586/51,483) in Tanzania. The distribution of the survey population was significantly different from the census distribution. In both countries, IVR respondents were younger, were predominantly male, and had higher education levels than CATI respondents. IVR respondents had a lower response rate than CATI respondents in Bangladesh (adjusted odds ratio [AOR]=0.73, 95% CI 0.54-0.99) and Tanzania (AOR=0.32, 95% CI 0.16-0.60). The cooperation rate was also lower with IVR than with CATI in Bangladesh (AOR=0.12, 95% CI 0.07-0.20) and Tanzania (AOR=0.28, 95% CI 0.14-0.56). Both in Bangladesh (AOR=0.33, 95% CI 0.25-0.43) and Tanzania (AOR=0.09, 95% CI 0.06-0.14), there were fewer completed interviews with IVR than with CATI; however, there were more partial interviews with IVR than with CATI in both countries. CONCLUSIONS There were lower completion, response, and cooperation rates with IVR than with CATI in both countries. This finding suggests that, to increase representativeness in certain settings, a selective approach may be needed to design and deploy mobile phone surveys to increase population representativeness. Overall, CATI surveys may offer a promising approach for surveying potentially under-represented groups like women, rural residents, and participants with lower levels of education in some countries.
Collapse
Affiliation(s)
- George Pariyo
- Makerere University School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ankita Meghani
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dustin Gibson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States
| | - Alain Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Iqbal Ansary Khan
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | | | - Honorati Masanja
- Ifakara Health Institute, Dar es Salam, United Republic of Tanzania
| | - Adnan Ali Hyder
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Saifuddin Ahmed
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
20
|
Modlin C, Sugarman J, Chongwe G, Kass N, Nazziwa W, Tegli J, Shrestha P, Ali J. Towards achieving transnational research partnership equity: lessons from implementing adaptive platform trials in low- and middle-income countries. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18915.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background: Use of adaptive clinical trials, particularly adaptive platform trials, has grown exponentially in response to the coronavirus disease (COVID-19) pandemic. Implementation of these trials in low- and middle-income countries (LMICs) has been fostered through the formation or modification of transnational research partnerships, typically between research groups from LMICs and high-income countries (HICs). While these partnerships are important to promote collaboration and overcome the structural and economic disadvantages faced by LMIC health researchers, it is critical to focus attention on the multiple dimensions of partnership equity. Methods: Based on informal literature reviews and meetings with leaders of one of the multinational COVID-19 adaptive platform trials, we describe what can be learned about research partnership equity from these experiences. Results: We organize these considerations into eight thematic categories: 1) epistemic structures, 2) funding, 3) ethics oversight, 4) regulatory oversight, 5) leadership, 6) post-trial access to interventions, data, and specimens, 7) knowledge translation, and 8) research capacity strengthening and maintenance. Within each category we review the normative claims that support its relevance to research partnership equity followed by discussion of how adaptive platform trials highlight new dimensions, considerations, or challenges. Conclusion: These observations provide insight into procedural and substantive equity-building measures within transnational global health research partnerships more broadly.
Collapse
|
21
|
Mubarak E, Kaur S, Min MTK, Hughes MT, Rushton CH, Ali J. Emerging Experiences with Virtual Clinical Ethics Consultation: Case Studies from the United States and Malaysia. J Clin Ethics 2023; 34:51-57. [PMID: 36940355 PMCID: PMC10184515 DOI: 10.1086/723317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
AbstractThe COVID-19 pandemic has inspired numerous opportunities for telehealth implementation to meet diverse healthcare needs, including the use of virtual communication platforms to facilitate the growth of and access to clinical ethics consultation (CEC) services across the globe. Here we discuss the conceptualization and implementation of two different virtual CEC services that arose during the COVID-19 pandemic: the Clinical Ethics Malaysia COVID-19 Consultation Service and the Johns Hopkins Hospital Ethics Committee and Consultation Service. A common strength experienced by both platforms during virtual delivery included improved ability for local practitioners to address consultation needs for patient populations otherwise unable to access CEC services in their respective locations. Additionally, virtual platforms allowed for enhanced collaboration and sharing of expertise among ethics consultants. Both contexts encountered numerous challenges related to patient care delivery during the pandemic. The use of virtual technologies resulted in decreased personalization of patient-provider communication. We discuss these challenges with respect to contextual differences specific to each service and setting, including differences in CEC needs, sociocultural norms, resource availability, populations served, consultation service visibility, healthcare infrastructure, and funding disparities. Through lessons learned from a health system in the United States and a national service in Malaysia, we provide key recommendations for health practitioners and clinical ethics consultants to leverage virtual communication platforms to mitigate existing inequities in patient care delivery and increase capacity for CEC globally.
Collapse
|
22
|
Ali J, Nagarajan M, Mwaka ES, Rutebemberwa E, Vecino-Ortiz AI, Quintero AT, Rodriguez-Patarroyo M, Maniar V, Al Kibria GM, Labrique AB, Pariyo GW, Gibson DG. Remote consent approaches for mobile phone surveys of non-communicable disease risk factors in Colombia and Uganda: A randomized study. PLoS One 2022; 17:e0279236. [PMID: 36542631 PMCID: PMC9770397 DOI: 10.1371/journal.pone.0279236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Automated mobile phone surveys (MPS) can be used to collect public health data of various types to inform health policy and programs globally. One challenge in administering MPS is identification of an appropriate and effective participant consent process. This study investigated the impact of different survey consent approaches on participant disposition (response characteristics and understanding of the purpose of the survey) within the context of an MPS that measured noncommunicable disease (NCD) risk factors across Colombia and Uganda. METHODS Participants were randomized to one of five consent approaches, with consent modules varying by the consent disclosure and mode of authorization. The control arm consisted of a standard consent disclosure and a combined opt-in/opt-out mode of authorization. The other four arms consist of a modified consent disclosure and one of four different forms of authorization (i.e., opt-in, opt-out, combined opt-in/opt-out, or implied). Data related to respondent disposition and respondent understanding of the survey purpose were analyzed. RESULTS Among 1889 completed surveys in Colombia, differences in contact, response, refusal, and cooperation rates by study arms were found. About 68% of respondents correctly identified the survey purpose, with no significant difference by study arm. Participants reporting higher levels of education and urban residency were more likely to identify the purpose correctly. Participants were also more likely to accurately identify the survey purpose after completing several survey modules, compared to immediately following the consent disclosure (78.8% vs 54.2% correct, p<0.001). In Uganda, 1890 completed surveys were collected. Though there were differences in contact, refusal, and cooperation rates by study arm, response rates were similar across arms. About 37% of respondents identified the survey purpose correctly, with no difference by arm. Those with higher levels of education and who completed the survey in English were able to more accurately identify the survey purpose. Again, participants were more likely to accurately identify the purpose of the survey after completing several NCD modules, compared to immediately following the consent module (42.0% vs 32.2% correct, p = 0.013). CONCLUSION This study contributes to the limited available evidence regarding consent procedures for automated MPS. Future studies should develop and trial additional interventions to enhance consent for automated public health surveys, and measure other dimensions of participant engagement and understanding.
Collapse
Affiliation(s)
- Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Madhuram Nagarajan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Erisa S. Mwaka
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Andres I. Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Vidhi Maniar
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alain B. Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - George W. Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dustin G. Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| |
Collapse
|
23
|
Nour E, Halloul R, Jaziri H, Hammami A, Dahmeni W, Ksiaa M, Ali J. La cholangite biliaire primitive séronégative aura-t-elle un profil évolutif plus favorable que la forme classique ? Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
24
|
Halloul R, Nour E, Dahmeni W, Hammami A, Ksiaa M, Jaziri H, Ali J. L’ALBI score : une alternative aux scores MELD et Child-Pugh au cours de la cholangite biliaire primitive au stade de cirrhose ? Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
25
|
Nour E, Halloul R, Jaziri H, Hammami A, Dahmeni W, Ksiaa M, Ali J. Cholangite biliaire primitive : impact de l’atteinte osseuse sur le profil évolutif de la maladie. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
26
|
Halloul R, Nour E, Chatti O, Dahmeni W, Jaziri H, Ksiaa M, Hammami A, Ali J. Cholangite biliaire primitive : les nouveaux scores pronostiques quantitatifs font-ils mieux que les anciens scores qualitatifs ? Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
27
|
Khayat L, Aya H, Mestiri S, Nour E, Aida B, Mehdi K, Salem A, Ahlem B, Jaziri H, Ali J. Facteurs de risque associés à une mauvaise qualité du sommeil chez les patients atteints d’une maladie inflammatoire chronique de l’intestin. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
28
|
Aya H, Khayat L, Jaziri H, Mestiri S, Aida B, Mehdi K, Salem A, Ahlem B, Nour E, Ali J. La surexposition aux rayonnements ionisants chez les patients atteints de la maladie de Crohn : facteurs de risque associés. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
29
|
Conic J, Lapinel N, Ali J, Boulmay B. Association between non-tuberculous mycobacterial infection and aerodigestive cancers: A case series highlighting different features, sequence and association. Respir Med Case Rep 2022; 40:101751. [PMID: 36262772 PMCID: PMC9574767 DOI: 10.1016/j.rmcr.2022.101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022] Open
Abstract
Non-tuberculous mycobacterial lung disease (NTM-LD) is increasingly recognized as an important cause of chronic respiratory infections. Diagnosing NTM infection in patients with a history of cancer can be delayed, or overlooked, due to potential overlapping symptomatology and similarities among radiographic features, including lung masses, cavities, and nodules. This retrospective case series aims to demonstrate the variable association of NTM-LD and aerodigestive cancers and how in some cases the diagnosis of NTM-LD can be delayed in patients with malignancy. Six patients with biopsy proven aerodigestive malignancy (either lung or head & neck cancer) and culture positive NTM infection were identified through a retrospective review of medical records between 1/1/2013 and 9/20/2020. Their demographic characteristics and clinical course are described to help elucidate both similarities and differences in presentation and diagnosis. Awareness of the association of NTM-LD and lung malignancy may help in early identification of these potential comorbidities and hence influence proactive diagnosis and management.
Collapse
Affiliation(s)
- J. Conic
- Louisiana State University Health Sciences Center- Department of Internal Medicine, New Orleans, LA, USA,Corresponding author.
| | - N. Lapinel
- Louisiana State University Health Sciences Center- Department of Internal Medicine, Section of Pulmonary/Critical Care & Allergy Immunology, New Orleans, LA, USA
| | - J. Ali
- Louisiana State University Health Sciences Center- Department of Internal Medicine, Section of Pulmonary/Critical Care & Allergy Immunology, New Orleans, LA, USA
| | - B. Boulmay
- Louisiana State University Health Sciences Center- Department of Internal Medicine, Section of Hematology/Oncology, New Orleans, LA, USA
| |
Collapse
|
30
|
Xiao Y, Jiang Y, Tan P, Kong K, Ali J, Mustafina R, Zhu H, Cai D. Investigating Morphology and Breakage Evolution Characteristics of Railroad Ballasts over Distinct Supports Subjected to Impact Loading. Materials (Basel) 2022; 15:6295. [PMID: 36143611 PMCID: PMC9505978 DOI: 10.3390/ma15186295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
The ballast bed constantly degrades under the repeated applications of impact loading exerted by passing trains in terms of the particle size, shape, breakage, fouling, etc., thus significantly jeopardizing the in-service performance and operational safety of ballasted tracks. In this study, the morphology and breakage evolution characteristics of railroad ballasts of single- and multiple-size ranges were investigated from laboratory impact-load tests. Both a concrete block and sand layer were placed to mimic the distinct under-ballast supports. The degradation trends of the typical shape and breakage indices were comparatively quantified for different combinations of ballast particle sizes and shapes, under-ballast supports, impact energies, and number of impact-load applications (N). The results show that both shape and size affect ballast particle breakage, with shape being more influential. The breakage severity of flake-like particles is about 1.5-1.66 times and 1.25-1.5 times higher than those of regular and needle-like particles, respectively. Under impact loading, large and small single-size ballasts degrade mainly by breakage and abrasion, respectively. The modified fouling index (FI) of flake-like particles within 31.5-40 mm is about 3.6 times that of regular particles within 50-63 mm. The shape indices of the ballast particles within 31.5-40 mm exhibit the most profound changes. The severities of the ballast breakage and fines generation (or modified FI) increased by 50% and 74%, respectively, due to the increase in the under-ballast support stiffness by 100 times and the drop height of 80 cm, respectively. The convexity and ballast breakage index (BBI) are promising for quantifying particle-degradation trends, and their statistical correlation found herein is potentially useful for the transition of ballast-bed-maintenance management from the current plan-based scheduling to condition-based upgrading.
Collapse
Affiliation(s)
- Yuanjie Xiao
- School of Civil Engineering, Central South University, Changsha 410075, China
- Ministry of Education (MOE) Key Laboratory of Engineering Structures of Heavy Haul Railway (Central South University), Changsha 410075, China
| | - Yu Jiang
- School of Civil Engineering, Central South University, Changsha 410075, China
| | - Pan Tan
- School of Civil Engineering, Central South University, Changsha 410075, China
| | - Kunfeng Kong
- School of Civil Engineering, Central South University, Changsha 410075, China
- State Key Laboratory for High-Speed Railway Track Technology, China Academy of Railway Sciences Corporation Limited, Beijing 100081, China
| | - Joseph Ali
- School of Civil Engineering, Central South University, Changsha 410075, China
| | - Ralina Mustafina
- School of Civil Engineering, Central South University, Changsha 410075, China
| | - Hongwei Zhu
- State Key Laboratory for High-Speed Railway Track Technology, China Academy of Railway Sciences Corporation Limited, Beijing 100081, China
| | - Degou Cai
- State Key Laboratory for High-Speed Railway Track Technology, China Academy of Railway Sciences Corporation Limited, Beijing 100081, China
| |
Collapse
|
31
|
Ochieng J, Kwagala B, Barugahare J, Mwaka E, Ekusai-Sebatta D, Ali J, Sewankambo NK. Perspectives and experiences of researchers regarding feedback of incidental genomic research findings: A qualitative study. PLoS One 2022; 17:e0273657. [PMID: 36037169 PMCID: PMC9423610 DOI: 10.1371/journal.pone.0273657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
There is a plethora of unanswered ethical questions about sharing incidental findings in genetics and genomics research. Yet understanding and addressing such issues is necessary for communicating incidental findings with participants. We explored researchers’ perspectives and experiences regarding feedback of incidental genomics findings to participants.
Methods
This was a qualitative study using semi-structured interview schedules for In-depth interviews. Thirty respondents were purposively selected based on role as genetics and genomics researchers in Uganda. Data were analysed through content analysis to identify emerging themes using a comprehensive thematic matrix. QSR International NVivo software was used to support data analysis.
Results
a). On perceptions, sharing of incidental findings was acceptable and four themes emerged including role of professional judgement; role of ethics committees and ethical guidelines; optimal disclosure practices; limits to professional duty and uncertainty and; b). on practices, sharing had been carried out by some researchers and a theme on experience and practices emerged.
Conclusion
Feedback of incidental genomics research findings to participants is generally acceptable to researchers. Some researchers. Challenges include lack of ethical guidelines and uncertainty about the findings.
Collapse
Affiliation(s)
- Joseph Ochieng
- Makerere University School of Biomedical Sciences, Kampala, Uganda
- * E-mail:
| | - Betty Kwagala
- Makerere University School of Business and Management Studies, Kampala, Uganda
| | - John Barugahare
- Makerere University School of Liberal and Performing Arts, Kampala, Uganda
| | - Erisa Mwaka
- Makerere University School of Biomedical Sciences, Kampala, Uganda
| | | | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States of America
| | | |
Collapse
|
32
|
Zulu VC, Syakalima M, Ali J. Ethical dimensions of zoonotic disease research: Perspectives of traditional livestock keepers in Zambia. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17962.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: With the increase in zoonotic disease research using livestock belonging to traditional livestock keepers (LKs) as research subjects, careful attention to both animal and livestock keeper interests is critically important in Zambia and other similar contexts. Methods: The study aimed to explore ethics-related challenges during zoonotic disease research among LKs where their livestock are included as research subjects. The study was implemented in the Southern province of Zambia in July 2020. Three focus group discussions (FGDs) involving 30 adult male LKs living in livestock-wildlife interface areas where zoonotic diseases are likely to occur, were carried out. The FGDs were done in the local language and audio recorded. Thematic analysis was done using field notes and translated and transcribed recorded interviews. Results: The study found that trust between the researchers and LKs when their livestock are used as research subjects was very cardinal and depended on the continual presence of the local veterinary assistant (VA) during the conduct of research. Conclusions: The LKs could be considered a vulnerable population when their livestock were used as research subjects as, being resource poor, they were looking to researchers to provide benefits yet not fully understanding the research, and thus did not worry so much about consent procedures, bringing into question the validity of the oral consent obtained. The study also found that opportunities to strengthen trust and enhance the research experience could be exploited by researchers conducting research that is locally relevant and desired, being aware of procedural preferences for entering into livestock keeping communities, adequate disclosure of research procedures, respecting conventions and traditional cultural beliefs, and returning results of research. The findings of this study can be used by both researchers as they carry-out zoonotic disease research and by Research Ethics Committees.
Collapse
|
33
|
Kahn J, Ali J, Kingori P, Merritt M, Murray C, Parker M. GLIDE Wellcome Open Research Gateway. Wellcome Open Res 2022; 7:176. [PMID: 36324703 PMCID: PMC9608250 DOI: 10.12688/wellcomeopenres.17985.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/20/2022] Open
Abstract
The Global Infectious Disease Ethics (GLIDE) Collaborative is launching a new Wellcome Open Research (WOR) Gateway, and we as the leaders of GLIDE hope to encourage submissions to this timely and necessary new platform for publishing open access peer-reviewed articles focusing on this area.
Collapse
Affiliation(s)
- Jeffrey Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21208, USA
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21208, USA
| | - Patricia Kingori
- Wellcome Centre for Ethics and Humanities, Oxford University, Oxford, UK
| | - Maria Merritt
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21208, USA
| | - Claire Murray
- Wellcome Centre for Ethics and Humanities, Oxford University, Oxford, UK
| | - Michael Parker
- Wellcome Centre for Ethics and Humanities, Oxford University, Oxford, UK
| |
Collapse
|
34
|
Tackett S, Sugarman J, Ng CJ, Kamarulzaman A, Ali J. Developing a competency framework for health research ethics education and training. J Med Ethics 2022; 48:391-396. [PMID: 33811112 PMCID: PMC8486875 DOI: 10.1136/medethics-2021-107237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 05/26/2023]
Abstract
Health research ethics (HRE) training programmes are being developed and implemented globally, often with a goal of increasing local capacity to assure ethical conduct in health-related research. Yet what it means for there to be sufficient HRE capacity is not well-defined, and there is currently no consensus on outcomes that HRE training programmes should collectively intend to achieve. Without defining the expected outcomes, meaningful evaluation of individual participants and programmes is challenging. In this article, we briefly describe the evolution of formal education in HRE, articulate the need for a framework to define outcomes for HRE training programmes, and provide guidance for developing HRE competency frameworks that define outcomes suited to their contexts. We detail critical questions for developing HRE competency frameworks using a six-step process: (1) define the purposes, intended uses and scope of the framework; (2) describe the context in which practice occurs; (3) gather data using a variety of methods to inform the competency framework; (4) translate the data into competencies that can be used in educational programmes; (5) report on the competency development process and results and (6) evaluate and update the competency framework. We suggest that competency frameworks should be feasible to develop using this process, and such efforts promise to contribute to programmatic advancement.
Collapse
Affiliation(s)
- Sean Tackett
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Adeeba Kamarulzaman
- Department of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
35
|
Gibson DG, Kibria GMA, Pariyo GW, Ahmed S, Ali J, Labrique AB, Khan IA, Rutebemberwa E, Flora MS, Hyder AA. Promised and Lottery Airtime Incentives to Improve Interactive Voice Response Survey Participation Among Adults in Bangladesh and Uganda: Randomized Controlled Trial. J Med Internet Res 2022; 24:e36943. [PMID: 35532997 PMCID: PMC9127645 DOI: 10.2196/36943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Increased mobile phone penetration allows the interviewing of respondents using interactive voice response surveys in low- and middle-income countries. However, there has been little investigation of the best type of incentive to obtain data from a representative sample in these countries. Objective We assessed the effect of different airtime incentives options on cooperation and response rates of an interactive voice response survey in Bangladesh and Uganda. Methods The open-label randomized controlled trial had three arms: (1) no incentive (control), (2) promised airtime incentive of 50 Bangladeshi Taka (US $0.60; 1 BDT is approximately equivalent to US $0.012) or 5000 Ugandan Shilling (US $1.35; 1 UGX is approximately equivalent to US $0.00028), and (3) lottery incentive (500 BDT and 100,000 UGX), in which the odds of winning were 1:20. Fully automated random-digit dialing was used to sample eligible participants aged ≥18 years. The risk ratios (RRs) with 95% confidence intervals for primary outcomes of response and cooperation rates were obtained using log-binomial regression. Results Between June 14 and July 14, 2017, a total of 546,746 phone calls were made in Bangladesh, with 1165 complete interviews being conducted. Between March 26 and April 22, 2017, a total of 178,572 phone calls were made in Uganda, with 1248 complete interviews being conducted. Cooperation rates were significantly higher for the promised incentive (Bangladesh: 39.3%; RR 1.38, 95% CI 1.24-1.55, P<.001; Uganda: 59.9%; RR 1.47, 95% CI 1.33-1.62, P<.001) and the lottery incentive arms (Bangladesh: 36.6%; RR 1.28, 95% CI 1.15-1.45, P<.001; Uganda: 54.6%; RR 1.34, 95% CI 1.21-1.48, P<.001) than those for the control arm (Bangladesh: 28.4%; Uganda: 40.9%). Similarly, response rates were significantly higher for the promised incentive (Bangladesh: 26.5%%; RR 1.26, 95% CI 1.14-1.39, P<.001; Uganda: 41.2%; RR 1.27, 95% CI 1.16-1.39, P<.001) and lottery incentive arms (Bangladesh: 24.5%%; RR 1.17, 95% CI 1.06-1.29, P=.002; Uganda: 37.9%%; RR 1.17, 95% CI 1.06-1.29, P=.001) than those for the control arm (Bangladesh: 21.0%; Uganda: 32.4%). Conclusions Promised or lottery airtime incentives improved survey participation and facilitated a large sample within a short period in 2 countries. Trial Registration ClinicalTrials.gov NCT03773146; http://clinicaltrials.gov/ct2/show/NCT03773146
Collapse
Affiliation(s)
| | | | | | - Saifuddin Ahmed
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Iqbal Ansary Khan
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Elizeus Rutebemberwa
- Makerere University School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Adnan Ali Hyder
- Milken Institute School of Public Health, George Washington University, Washington DC, MD, United States
| |
Collapse
|
36
|
Osman M, Doukas G, Namjoshi G, Khalil R, Ali J, Bhusari S. Spilled gallstone mimicking right middle lobe pulmonary nodule. Ann R Coll Surg Engl 2022; 104:29-31. [PMID: 35100861 DOI: 10.1308/rcsann.2021.0747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Laparoscopic cholecystectomy is the standard of care for the surgical management of symptomatic gallstone disease. Gallstone spillage at laparoscopic cholecystectomy is common, with a reported incidence of 0.2-20%. In the majority of cases there are no complications associated with this spillage, but a series of studies report patients with complications of free peritoneal gallstones. We present a case of migration of gallstone to the lung resulting in an inflammatory mass in the right middle lobe as a complication of spillage at laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- M Osman
- Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
| | - G Doukas
- Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
| | - G Namjoshi
- Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
| | - R Khalil
- Ain Shams University, Cairo, Egypt
| | - J Ali
- Royal Papworth Hospital NHS Foundation Trust, UK
| | - S Bhusari
- Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
37
|
Hutler B, Blasimme A, Gur-Arie R, Ali J, Barnhill A, Hood A, Kahn J, Perkins NL, Regenberg A, Vayena E. Assessing the Governance of Digital Contact Tracing in Response to COVID-19: Results of a Multi-National Study. J Law Med Ethics 2022; 50:791-804. [PMID: 36883392 DOI: 10.1017/jme.2023.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This paper describes the results of a multi-country survey of governance approaches for the use of digital contact tracing (DCT) in response to the COVID-19 pandemic. We argue that the countries in our survey represent two distinct models of DCT governance, both of which are flawed. The "data protection model" emphasizes privacy protections at the expense of public health benefit, while the "emergency response model" sacrifices transparency and accountability, prompting concerns about excessive governance surveillance. The ethical and effective use of DCT in the future requires a new governance approach that is better suited to this novel use of mobile phone data to promote public health."
Collapse
Affiliation(s)
| | | | | | - Joseph Ali
- JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD, USA
| | | | - Amelia Hood
- JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD, USA
| | | | | | | | | |
Collapse
|
38
|
Osman M, Doukas G, Namjoshi G, Khalil R, Ali J, Bhusari S. Spilled gallstone mimicking right middle lobe pulmonary nodule. Ann R Coll Surg Engl 2021; 104:e29-e31. [PMID: 34807771 DOI: 10.1308/rcsann.2021.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Laparoscopic cholecystectomy is the standard of care for the surgical management of symptomatic gallstone disease. Gallstone spillage at laparoscopic cholecystectomy is common, with a reported incidence of 0.2-20%. In the majority of cases there are no complications associated with this spillage, but a series of studies report patients with complications of free peritoneal gallstones. We present a case of migration of gallstone to the lung resulting in an inflammatory mass in the right middle lobe as a complication of spillage at laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- M Osman
- Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
| | - G Doukas
- Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
| | - G Namjoshi
- Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
| | - R Khalil
- Ain Shams University, Cairo, Egypt
| | - J Ali
- Royal Papworth Hospital NHS Foundation Trust, UK
| | - S Bhusari
- Basildon and Thurrock University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
39
|
Ochieng J, Kwagala B, Barugahare J, Mwaka E, Ekusai-Sebatta D, Ali J, Sewankambo NK. Perspectives and ethical considerations for return of genetics and genomics research results: a qualitative study of genomics researchers in Uganda. BMC Med Ethics 2021; 22:154. [PMID: 34798900 PMCID: PMC8603565 DOI: 10.1186/s12910-021-00724-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The return of genetics and genomics research results has been a subject of ongoing global debate. Such feedback is ethically desirable to update participants on research findings particularly those deemed clinically significant. Although there is limited literature, debate continues in African on what constitutes appropriate practice regarding the return of results for genetics and genomics research. This study explored perspectives and ethical considerations of Ugandan genomics researchers regarding the return of genetics and genomics research results. METHODS This was a qualitative study that employed in-depth interviews. Thirty participants were purposively selected based on their expertise as genomics researchers in Uganda. Data were analysed through content analysis along the main themes of the study using a comprehensive thematic matrix, to identify common patterns arising from the narratives. NVivo software 12 was used to support data analysis. RESULTS The return of genetics and genomics research results was generally acceptable to researchers, and some indicated that they had previously returned individual or aggregate results to participants and communities. The main reasons cited for sharing research results with participants included their clinical utility, actionability and overall benefit to society. Ethical considerations for appropriate return of results included a need for effective community engagement, genetic counselling prior to disclosure of the results, adequate informed consent, and proper assessment of the implications of, or consequences of returning of results. However, the approaches to return of results were perceived as unstandardized due to the lack of appropriate regulatory frameworks. CONCLUSIONS The return of genetic and genomic research results is generally acceptable to researchers despite the lack of appropriate regulatory frameworks. Ethical considerations for return of genetics and genomics research results are highly divergent, hence the need for national ethical guidelines to appropriately regulate the practice.
Collapse
Affiliation(s)
- Joseph Ochieng
- Department of Anatomy, College of Health Sciences, School of Biomedical Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Betty Kwagala
- School of Business and Management Studies, Makerere University, Kampala, Uganda
| | | | - Erisa Mwaka
- Department of Anatomy, College of Health Sciences, School of Biomedical Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Deborah Ekusai-Sebatta
- Department of Anatomy, College of Health Sciences, School of Biomedical Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, USA
| | | |
Collapse
|
40
|
Ali J, Antonelli M, Bastian L, Becker W, Brandt CA, Burgess DJ, Burns A, Cohen SP, Davis AF, Dearth CL, Dziura J, Edwards R, Erdos J, Farrokhi S, Fritz J, Geda M, George SZ, Goertz C, Goodie J, Hastings SN, Heapy A, Ilfeld BM, Katsovich L, Kerns RD, Kyriakides TC, Lee A, Long CR, Luther SL, Martino S, Matheny ME, McGeary D, Midboe A, Pasquina P, Peduzzi P, Raffanello M, Rhon D, Rosen M, Esposito ER, Scarton D, Hastings SN, Seal K, Silliker N, Taylor S, Taylor SL, Tsui M, Wright FS, Zeliadt S. Optimizing the Impact of Pragmatic Clinical Trials for Veteran and Military Populations: Lessons From the Pain Management Collaboratory. Mil Med 2021; 187:179-185. [PMID: 34791412 PMCID: PMC9389906 DOI: 10.1093/milmed/usab458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/12/2022] Open
Abstract
Pragmatic clinical trials (PCTs) are well-suited to address unmet healthcare needs, such as those arising from the dual public health crises of chronic pain and opioid misuse, recently exacerbated by the COVID-19 pandemic. These overlapping epidemics have complex, multifactorial etiologies, and PCTs can be used to investigate the effectiveness of integrated therapies that are currently available but underused. Yet individual pragmatic studies can be limited in their reach because of existing structural and cultural barriers to dissemination and implementation. The National Institutes of Health, Department of Defense, and Department of Veterans Affairs formed an interagency research partnership, the Pain Management Collaboratory. The partnership combines pragmatic trial design with collaborative tools and relationship building within a large network to advance the science and impact of nonpharmacological approaches and integrated models of care for the management of pain and common co-occurring conditions. The Pain Management Collaboratory team supports 11 large-scale, multisite PCTs in veteran and military health systems with a focus on team science with the shared aim that the "whole is greater than the sum of the parts." Herein, we describe this integrated approach and lessons learned, including incentivizing all parties; proactively offering frequent opportunities for problem-solving; engaging stakeholders during all stages of research; and navigating competing research priorities. We also articulate several specific strategies and their practical implications for advancing pain management in active clinical, "real-world," settings.
Collapse
Affiliation(s)
- Joseph Ali
- Johns Hopkins Berman Institute of Bioethics and Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Margaret Antonelli
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - William Becker
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Diana J Burgess
- Minneapolis VA Health Care System, Minneapolis, MN 55417, USA,University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Amy Burns
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Steven P Cohen
- Johns Hopkins Medical Institutions, Clarksville, MD 21029, USA0
| | - Alison F Davis
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Christopher L Dearth
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA,Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Jim Dziura
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Rob Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham and Women’s Hospital, Chestnut Hill, MA 02467, USA
| | - Joe Erdos
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Shawn Farrokhi
- Naval Medical Center San Diego, Department of Physical Therapy, San Diego, CA 92134, USA
| | - Julie Fritz
- University of Utah, College of Health, Salt Lake City, UT 84108, USA
| | - Mary Geda
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, NC 27715, USA
| | | | - Jeffrey Goodie
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Susan N Hastings
- Duke University School of Medicine, Durham, NC 27710, USA,Durham VA Health Care System, Durham, NC 27705, USA
| | - Alicia Heapy
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego School of Medicine, LaJolla, CA 92093, USA
| | - Lily Katsovich
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Robert D Kerns
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Tassos C Kyriakides
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Allison Lee
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Davenport, IA 52803, USA
| | - Stephen L Luther
- James A. Haley Veterans Hospital, Tampa, FL 33612, USA,University of South Florida College of Public Health, Tampa, FL 33612, USA
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | - Michael E Matheny
- Tennessee Valley Healthcare System, Nashville, TN 37212, USA,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Don McGeary
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Amanda Midboe
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Paul Pasquina
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA,Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Peter Peduzzi
- Yale University School of Medicine, New Haven, CT 06520, USA
| | | | - Daniel Rhon
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Marc Rosen
- VA Connecticut Healthcare System, West Haven, CT 06516, USA,Yale University School of Medicine, New Haven, CT 06520, USA
| | | | - Dylan Scarton
- Henry Jackson Foundation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Susan N Hastings
- Durham VA Medical Center, Durham, NC 27701, USA,Department of Medicine, Duke University, Durham, NC 27708, USA
| | - Karen Seal
- University of California San Francisco, School of Medicine, San Francisco, CA 94143, USA,San Francisco VA Medical Center, San Francisco, CA 94121, USA
| | - Norman Silliker
- Yale University School of Medicine, New Haven, CT 06520, USA
| | - Sakasha Taylor
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Stephanie L Taylor
- VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA,University of California Los Angeles Department of Medicine and Department of Health Policy and Management, Los Angeles, CA 90095, USA
| | - Megan Tsui
- Henry Jackson Foundation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Fred S Wright
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Steven Zeliadt
- VA Puget Sound Health Care System, Seattle, WA 98108, USA,University of Washington, School of Public Health, Seattle, WA 98195, USA
| |
Collapse
|
41
|
Ali J, Davis AF, Burgess DJ, Rhon DI, Vining R, Young‐McCaughan S, Green S, Kerns RD. Justice and equity in pragmatic clinical trials: Considerations for pain research within integrated health systems. Learn Health Syst 2021; 6:e10291. [PMID: 35434355 PMCID: PMC9006531 DOI: 10.1002/lrh2.10291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/23/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Methods Results Conclusions
Collapse
Affiliation(s)
- Joseph Ali
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
- Johns Hopkins Berman Institute of Bioethics Baltimore Maryland USA
| | - Alison F. Davis
- Pain Management Collaboratory, Department of Psychiatry Yale University School of Medicine New Haven Connecticut USA
| | - Diana J. Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Medical Center Minneapolis Minnesota USA
- Department of Medicine University of Minnesota Medical School Minneapolis Minnesota USA
| | - Daniel I. Rhon
- Brooke Army Medical Center and Uniformed Services University of the Health Sciences Fort Sam Houston Texas USA
| | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic Davenport Iowa USA
| | - Stacey Young‐McCaughan
- The University of Texas Health Science Center Houston Texas USA
- South Texas Veterans Health Care System San Antonio Texas USA
| | - Sean Green
- Pain Management Collaboratory, Department of Psychiatry Yale University School of Medicine New Haven Connecticut USA
| | - Robert D. Kerns
- Departments of Psychiatry, Neurology, and Psychology Yale University New Haven Connecticut USA
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center West Haven Connecticut USA
| |
Collapse
|
42
|
Vecino-Ortiz AI, Nagarajan M, Katumba KR, Akhter S, Tweheyo R, Gibson DG, Ali J, Rutebemberwa E, Khan IA, Labrique A, Pariyo GW. A cost study for mobile phone health surveys using interactive voice response for assessing risk factors of noncommunicable diseases. Popul Health Metr 2021; 19:32. [PMID: 34183013 PMCID: PMC8240284 DOI: 10.1186/s12963-021-00258-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background This is the first study to examine the costs of conducting a mobile phone survey (MPS) through interactive voice response (IVR) to collect information on risk factors for noncommunicable diseases (NCD) in three low- and middle-income countries (LMIC); Bangladesh, Colombia, and Uganda. Methods This is a micro-costing study conducted from the perspective of the payer/funder with a 1-year horizon. The study evaluates the fixed costs and variable costs of implementing one nationally representative MPS for NCD risk factors of the adult population. In this costing study, we estimated the sample size of calls required to achieve a population-representative survey and associated incentives. Cost inputs were obtained from direct economic costs incurred by a central study team, from country-specific collaborators, and from platform developers who participated in the deployment of these MPS during 2017. Costs were reported in US dollars (USD). A sensitivity analysis was conducted assessing different scenarios of pricing and incentive strategies. Also, costs were calculated for a survey deployed targeting only adults younger than 45 years. Results We estimated the fixed costs ranging between $47,000 USD and $74,000 USD. Variable costs were found to be between $32,000 USD and $129,000 USD per nationally representative survey. The main cost driver was the number of calls required to meet the sample size, and its variability largely depends on the extent of mobile phone coverage and access in the country. Therefore, a larger number of calls were estimated to survey specific harder-to-reach sub-populations. Conclusion Mobile phone surveys have the potential to be a relatively less expensive and timely method of collecting survey information than face-to-face surveys, allowing decision-makers to deploy survey-based monitoring or evaluation programs more frequently than it would be possible having only face-to-face contact. The main driver of variable costs is survey time, and most of the variability across countries is attributable to the sampling differences associated to reaching out to population subgroups with low mobile phone ownership or access. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00258-z.
Collapse
Affiliation(s)
- Andres I Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA.
| | - Madhuram Nagarajan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
| | | | - Shamima Akhter
- Institute of Epidemiology, Disease control and Research, Dhaka, Bangladesh
| | - Raymond Tweheyo
- Makerere University School of Public Health, Kampala, Uganda
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
| | | | - Iqbal Ansary Khan
- Institute of Epidemiology, Disease control and Research, Dhaka, Bangladesh
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street., Suite E8620, Baltimore, MD, USA
| |
Collapse
|
43
|
Koloi-Keaikitse S, Geller G, Jankie D, Ali J. Cultural Values and Beliefs of Selected Local Communities in Botswana: Implications for Human Subject Research Ethics Practice. J Empir Res Hum Res Ethics 2021; 16:424-434. [PMID: 34096809 DOI: 10.1177/15562646211023332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Calls have been made for researchers prospectively and continuously to engage study communities. If done, this typically occurs through a specific research study or collaboration. Rarely are community mores examined in-depth to understand implications for research ethics policy processes. We describe a qualitative study designed to understand local community values, beliefs, and practices that relate to research ethics in Botswana and explore how communities would want their interests represented. Through focus group discussions across two different selected ethnic communities and in-depth interviews with paramount chiefs, we highlight a range of community values and expectations that represent concrete behavioral representations of respect and trustworthiness. Communities are willing to engage in the process of enhancing research and research ethics policies and procedures. We invite future research and training that seek to connect local conceptualizations of substantive and procedural aspects of research ethics.
Collapse
Affiliation(s)
| | - Gail Geller
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Dudu Jankie
- Department of Languages and Social Sciences Education, 54547University of Botswana, Gaborone, Botswana
| | - Joseph Ali
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
44
|
Elleuch N, Hamdi S, Ben Ameur W, Dahmani W, Aya H, Jaziri H, Ben Slama A, Ahlem B, Salem A, Ksiaa M, Ali J. Intérêt de la simulation dans l’annonce d’une mauvaise nouvelle : vécu des étudiants de médecine affectés aux services de Gastro-entérologie. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
45
|
Taylor HA, Washington D, Wang NY, Patel HD, Ford DE, Kass NE, Ali J. Randomized comparison of two interventions to enhance understanding during the informed consent process for research. Clin Trials 2021; 18:466-476. [PMID: 33892597 PMCID: PMC10173028 DOI: 10.1177/17407745211009529] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Many investigators have tested interventions to improve research participant understanding of information shared during the informed consent process, using a variety of methods and with mixed results. A valid criticism of most consent research is that studies are often conducted in simulated research settings rather than ongoing clinical studies. The present study rigorously tested two simple and easily adoptable strategies for presenting key consent information to participants eligible to enroll in six actual clinical trials (i.e. six parent studies). METHODS In collaboration with the study team from each parent study, we developed two consent interventions: a fact sheet and an interview-style video. The content of each of the intervention was based on the information shared in the consent form approved for each parent study. Participants were randomized to the standard consent process, or to one of the two interventions. Once exposed to the assigned consent mode, participants were asked to complete an assessment of understanding. The study was powered to determine whether those exposed to the fact sheet or video performed better on the consent assessment compared to those exposed to the standard consent. We also assessed participant satisfaction with the consent process. RESULTS A total of 284 participants were randomized to one of the three consent arms. Assessments of understanding were completed with a total of 273 participants from July 2017 to April 2019. Participants exposed to the video had better understanding scores compared to those exposed to the standard consent form process (p value = 0.020). Participants were more satisfied with the video when compared to the standard consent. Participants who received the fact sheet did not achieve higher overall understanding or satisfaction scores when compared to the standard consent process. CONCLUSION This randomized study of two novel consent interventions across six different clinical trials demonstrated a statistically significant difference in participant understanding based on overall scores among those exposed to the video intervention compared to those exposed to the standard consent.
Collapse
Affiliation(s)
- Holly A Taylor
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - Nae-Yuh Wang
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL, USA
| | - Daniel E Ford
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nancy E Kass
- Johns Hopkins Bloomberg School of Public Health and Berman Institute of Bioethics, Baltimore, MD, USA
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health and Berman Institute of Bioethics, Baltimore, MD, USA
| |
Collapse
|
46
|
Ali J, Cohn B, Mwaka E, Bollinger JM, Kwagala B, Barugahare J, Sewankambo NK, Ochieng J. A scoping review of genetics and genomics research ethics policies and guidelines for Africa. BMC Med Ethics 2021; 22:39. [PMID: 33810790 PMCID: PMC8017870 DOI: 10.1186/s12910-021-00611-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/30/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Genetics and genomics research (GGR) is increasingly being conducted around the world; yet, researchers and research oversight entities in many countries have struggled with ethical challenges. A range of ethics and regulatory issues need to be addressed through comprehensive policy frameworks that integrate with local environments. While important efforts have been made to enhance understanding and awareness of ethical dimensions of GGR in Africa, including through the H3Africa initiative, there remains a need for in-depth policy review, at a country-level, to inform and stimulate local policy development and revision on the continent. METHODS To identify and characterize existing ethics-related guidelines and laws applicable to GGR across much of Africa, we conducted a scoping review of English language policy documents identified through databases, repositories, and web searches. Thirty-six documents were included and coded using a framework that contained a range of themes across five analytical categories: (1) respect, (2) beneficence, (3) justice, (4) independent oversight, and (5) bans and prohibitions. Data analysis software (NVivo 12) was used to organize, code, and tabulate information according to document characteristics and topics. Illustrative examples of policy requirements were selected for inclusion. RESULTS Documents that met inclusion criteria spanned 20 years; published between 1996 and 2018, with the majority (58%) published after 2009. About two-thirds were denoted as "guidelines," and slightly more than half were non-exclusive to GGR. Very few (six) country-level documents identified were specific to GGR. Requirements related to the principle of "respect" appeared most often across all documents, relative to other principles and processes. The most commonly stated ban was on reproductive cloning. Other prohibitions applied to germline editing, undue inducements in research, sample use for commercial purposes, employee mandatory DNA testing, fetal sex selection, stem cell use, eugenics, and research without public health benefits. CONCLUSIONS Enforceable policies that are indispensable to the ethical conduct and review of GGR are either deficient or missing in many African countries. Existing international, GGR-specific ethics guidelines can be used to inform GGR policy development at a country-level, in conjunction with insight from country specific ethics committees and other local stakeholders.
Collapse
Affiliation(s)
- Joseph Ali
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Rm 208, Baltimore, MD, 21205, USA. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Betty Cohn
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Rm 208, Baltimore, MD, 21205, USA
| | - Erisa Mwaka
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juli M Bollinger
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Rm 208, Baltimore, MD, 21205, USA
| | - Betty Kwagala
- College of Business and Management, Makerere University, Kampala, Uganda
| | - John Barugahare
- Department of Philosophy, Makerere University, Kampala, Uganda
| | | | - Joseph Ochieng
- College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
47
|
Vokshi I, Ali J, Ansaripour A, Woolcock E, Cheshire C, Parameshwar J, Kydd A, Lewis C, Jenkins D, Tsui S, Kaul P, Large S, Berman M, Pettit S, Bhagra S. Surgical Palpation to Exclude Donor Transmitted Coronary Disease: A Single Centre Experience. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
48
|
Ansari MJ, Kohli K, Ali J. Preparation, Characterization and Dissolution Behaviour of Freeze Dried Complexes of Curcumin-Gamma Cyclodextrin. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i1131240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the current research was to develop and characterize curcumin-gamma cyclodextrin inclusion complexes in order to enhance solubility and rate of dissolution of poorly soluble curcumin. Based on the stoichiometric ratio of 1:1, the inclusion complexes of curcumin with γ-cyclodextrin were prepared by freeze drying method. The prepared dried and solidified inclusion complexes were characterized with the help of infrared spectroscopy, differential scanning calorimetry, and X-ray diffractometry. The comparative evaluation of solubility and rate of dissolution were investigated and compared with pure curcumin. Dissolution study demonstrated only 10% release from pure curcumin at 1 hour as opposed of approximately 72% release form freeze dried curcumin complexes. The freeze dried complexes exhibited almost complete release after 5 hours while only 34% release was observed from the pure curcumin during the same time period. Therefore, the freeze dried complex provided approximately 3 to 7-fold enhancement in the dissolution and release of curcumin over a period of 6 hours of dissolution testing. The kinetics of the in vitro release behaviors of the curcumin and curcumin complexes were investigated by applying various models such as zero order, first order, Higuchi and Peppas models. The release of the curcumin was observed to follow the first order release kinetics, since the correlation coefficient (R2) for the first order was the highest in comparison to other kinetic models.
Collapse
|
49
|
Torres-Quintero A, Vega A, Gibson DG, Rodriguez-Patarroyo M, Puerto S, Pariyo GW, Ali J, Hyder AA, Labrique A, Selig H, Peñaloza RE, Vecino-Ortiz AI. Adaptation of a mobile phone health survey for risk factors for noncommunicable diseases in Colombia: a qualitative study. Glob Health Action 2021; 13:1809841. [PMID: 32856572 PMCID: PMC7480483 DOI: 10.1080/16549716.2020.1809841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Data collection on noncommunicable disease (NCD) behavioral risk factors has traditionally been carried out through face-to-face surveys. However, its high costs and logistical difficulties can lead to lack of timely statistics for planning, particularly in low and middle-income countries. Mobile phone surveys (MPS) have the potential to fill these gaps. Objective This study explores perceptions, feasibility and strategies to increase the acceptability and response rate of health surveys administered through MPS using interactive voice response in Colombia. Method A sequential multimodal exploratory design was used. We conducted key informant interviews (KII) with stakeholders from government and academia; focus group discussions (FGDs) and user-group tests (UGTs) with young adults and elderly people living in rural and urban settings (men and women). The KII and FGDs explored perceptions of using mobile phones for NCD surveys. In the UGTs, participants were administered an IVR survey, and they provided feedback on its usability and potential improvement. Results Between February and November 2017, we conducted 7 KII, 6 FGDs (n = 54) and 4 UGTs (n = 34). Most participants consider MPS is a novel way to explore risk factors in NCDs. They also recognize challenges for their implementation including security issues, technological literacy and telecommunications coverage, especially in rural areas. It was recommended to promote the survey using mass media before its deployment and stressing its objectives, responsible institution and data privacy safeguards. The preferences in the survey administration relate to factors such as skills in the use of mobile phones, age, availability of time and educational level. The participants recommend questionnaires shorter than 10 minutes. Conclusions The possibility of obtaining data through MPS at a population level represents an opportunity to improve the availability of risk-factor data. Steps towards increasing the acceptability and overcoming technological and methodological challenges need to be taken.
Collapse
Affiliation(s)
| | - Angela Vega
- Institute of Public Health, Pontificia Universidad Javeriana , Bogotá, Colombia
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | | | - Stephanie Puerto
- Institute of Public Health, Pontificia Universidad Javeriana , Bogotá, Colombia
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Adnan A Hyder
- Department of Global Health, Milken Institute School of Public Health, George Washington University , Washington, DC, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Hannah Selig
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | | | - Andres I Vecino-Ortiz
- Institute of Public Health, Pontificia Universidad Javeriana , Bogotá, Colombia.,Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| |
Collapse
|
50
|
Rodriguez-Patarroyo M, Torres-Quintero A, Vecino-Ortiz AI, Hallez K, Franco-Rodriguez AN, Rueda Barrera EA, Puerto S, Gibson DG, Labrique A, Pariyo GW, Ali J. Informed Consent for Mobile Phone Health Surveys in Colombia: A Qualitative Study. J Empir Res Hum Res Ethics 2021; 16:24-34. [PMID: 32975157 PMCID: PMC8132005 DOI: 10.1177/1556264620958606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Public health surveys deployed through automated mobile phone calls raise a set of ethical challenges, including succinctly communicating information necessary to obtain respondent informed consent. This study aimed to capture the perspectives of key stakeholders, both experts and community members, on consent processes and preferences for participation in automated mobile phone surveys (MPS) of non-communicable disease risk factors in Colombia. We conducted semi-structured interviews with ethics and digital health experts and focus group discussions with community representatives. There was meaningful disagreement within both groups regarding the necessity of consent, when the purpose of a survey is to contribute to the formulation of public policies. Respondents who favored consent emphasized that consent communications ought to promote understanding and voluntariness, and implicitly suggested that information disclosure conform to a reasonable person standard. Given the automated and unsolicited nature of the phone calls and concerns regarding fraud, trust building was emphasized as important, especially for national MPS deployment. Community sensitization campaigns that provide relevant contextual information (such as the name of the administering institution) were thought to support trust-building. Additional ways to achieve the goals of consent while building trust in automated MPS for disease surveillance should be evaluated in order to inform ethical and effective practice.
Collapse
Affiliation(s)
| | | | - Andres I. Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristina Hallez
- Center for Effective Global Action, University of California, Berkeley, CA, USA
| | | | | | - Stephanie Puerto
- Institute of Public Health, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Dustin G. Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - George W. Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| |
Collapse
|