State-of-Knowledge and Guidance in EURAD Knowledge Management (Work Packages 11 State-of-Knowledge & 12 Guidance)

EURAD, the European Joint Programme on Radioactive Waste Management (RWM), is the European Research Programme on RWM, aimed at supporting member states with the implementation of their national programmes. It brings together over 100 organisations from different backgrounds and countries, which work together in RD&D projects, Strategic Studies and Knowledge Management (KM). The importance of KM is recognised by EURAD and reflected in a number of activities. One essential activity is the capture of the current State-of-Knowledge in the field of RWM and its transfer to the implementation of the different national programmes. This is done by different types of Knowledge Documents that are made available through a dedicated IT tool (e.g. a Wiki). The development of the individual EURAD KM documents is performed by recognised experts. These experts will share their view on the most relevant knowledge on a specific topic, highlighting safety functions and operational aspects. Additionally, signposting to pre-existing documents is performed (State-of-the-Art Documents, Scientific Papers, etc.). The hierarchy of the works for the KM documents (Theme Overview, Domain Insight, State-of-Knowledge, Guidance) is closely linked to the generic EURAD Roadmap/GBS (Goals Breakdown Structure). It provides a hierarchical structure that facilitates definition, organisation and communication of topics. All of this allows knowledge to be captured and presented with the level of detail that is required by the end-user, from a broad overview down to an increasing level of detail (pyramid of knowledge). To ensure the quality and consistency of the documents with the overall EURAD KM approach, quality assurance and editorial procedures are applied. Collection of end-user feedback will aid the optimisation and further development of the KM activities. To facilitate the transfer of knowledge, the EURAD KM programme goes beyond documents and strives to facilitate exchange between people and signpost to other resources, such as Training and Mobility activities (also organised by EURAD Work Package 13 Training & Mobility) or Communities of Practice. All these activities will contribute to a useful and end-user-friendly EURAD KM programme that is designed to be operational well beyond the runtime of EURAD-1. This presentation will provide further insight into the approaches, status of work and an outlook on future activities that will support member states with the implementation of their national programmes.

A tentative useful-for-all definition of “safety” in the context of radioactive waste disposal

Most, if not all, national programmes for radioactive waste management pledge their overall commitment to safety or – in the case of radioactive waste disposal – to long-term safety. Therefore, it may be somewhat surprising to find that the term “safety” is hardly defined in these programs. The same holds for some of the core international guidance literature on the deep geological repository (DGR) “safety case” concept. With respect to stakeholder concern over the safety of geological disposal, it seems, however, advisable to seek common ground in the understanding of the idea of “safety”. Hotzel and Schröder (2018) reviewed the most relevant international guidance literature for explicitly or implicitly provided definitions of “safety” in the context of radioactive waste disposal. Based on this study – and on the finding that a practical, useful-for-all definition of “safety” is not provided in the scanned literature – they developed a tentative dictionary-style definition of “safety” that is suitable for everyday use in the DGR context. In the current contribution I embed, expand and update the 2018 study at both ends: As an enhanced introduction to the 2018 study, I lay out a basic concept of “sound” glossary definitions, namely glossary definitions being both practical and correct (and what this means). The thesis is that sound glossary definitions can facilitate mutual understanding between different stakeholder groups. As an update to the actual proposal for the definition of “safety” from the Hotzel and Schröder (2018) paper, that was presented and discussed at the Waste Management Conference 2018, I review the latest international guidance literature and the stakeholder concerns raised at the 2018 conference in order to present a revised definition. As a seed of discussion, it may help to eventually expose possible mismatches in the base assumptions of safety experts and other stakeholders and thereby support meaningful communication.

Gender-related data missingness, imbalance and bias in global health surveys

Global surveys have built-in gender-related biases associated with data missingness across the gender dimensions of people’s lives, imbalanced or incomplete representation of population groups, and biased ways in which gender information is elicited and used. While increasing focus is being placed on the integration of sex-disaggregated statistics into national programmes and on understanding effects of gender-based disparities on the health of all people, the data necessary for elucidating underlying causes of gender disparities and designing effective intervention programmes continue to be lacking. Approaches exist, however, that can reasonably address some shortcomings, such as separating questions of gender identification from biological sex. Qualitative research can elucidate ways to rephrase questions and translate gendered terms to avoid perpetuating historical gender biases and prompting biased responses. Non-health disciplines may offer lessons in collecting gender-related data. Ultimately, multidisciplinary global collaborations are needed to advance this evolving field and to set standards for how we measure gender in all its forms.

Digital Engagement, Diversity and Access in Museum Education

In the wake of 2020’s Coronavirus pandemic, museums and galleries across the world were forced to close and many of these institutions turned to programming activities online rather than onsite. This paper explores that move from the physical to the digital realm through two case studies within the Learning and National Programmes department at The National Gallery in London. It addresses the obstacles and benefits of online working with two very different audiences, young people in education and a community group of people living with mental health difficulties. The paper seeks to elaborate on the specific challenges of working with these audiences and contribute to the development of best practice in the field.

Effects of COVID-19 on national tuberculosis elimination programme strategies during March to May 2020 on Tumkur district, India

Background: the nation-wide lockdown due global pandemic has disrupted a vital strategic intervention resulting in overall 60% decrease in presumptive and diagnostic TB cases during the lockdown period.Methods: A discrete choice experimental (DCE) exploratory operational research conducted during March to May 2020.Results: Health care services were affected 25% reduction in the outpatient department (OPD) in comparison to the previous year the same period. A gradual reduction in negative sputum cases undergoing chest radiography from 54% to 14%. Due to restricted movement LPA tests have been reduced 25% among the diagnosed TB cases, and private referrals to cartridge based nucleic acid amplification test (CBNAAT) services were reduced to 20%.Conclusions: Health services, including national programmes to combat TB, need to be actively engaged in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained. While experience on COVID-19 infection in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted. TB patients should take precautions as advised by health authorities to be protected from COVID-19 and continue their TB treatment as prescribed.

HIV/HBV coinfection: temporal trends and patient characteristics, Spain, 2002 to 2018

Background Recent and reliable estimates on the prevalence of coinfection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in Europe are lacking. Aim Leveraged on a study designed to assess HIV/HCV coinfection prevalence, we assessed the prevalence of HIV/HBV coinfection in Spain in 2018 and compared the results with five similar studies performed since 2002. Methods This cross-sectional prevalence study was carried out in 43 centres, and patients were selected using simple random sampling. The reference population comprised 40,322 patients and the sample size were 1,690 patients. Results The prevalence of HIV/HBV coinfection in Spain at the end of 2018 was 3.2%. The prevalence in 2002, 2009, 2015, 2016 and 2017 was 4.9%, 3.4%, 3%, 3.9% and 3%, respectively. Among the HIV/HBV-coinfected patients identified in 2018, 16.7% had cirrhosis according to transient elastography and 26.3% tested positive for antibodies against hepatitis D virus. All HIV/HBV-coinfected patients were receiving drugs with activity against HBV, and 97% of those tested for HBV DNA had an HBV DNA load < 80 IU/mL. Conclusions The prevalence of HIV/HBV coinfection in Spain remained stable at around 3% for a decade. Our data could facilitate the design of national programmes to control HBV infection and help identify areas of patient management that need improvement.

An insight into the prevalence of low birth weight in Madhya Pradesh

Background: The objective of the study was to to find out the prevalence of low birth weight in Sanwer block in Madhya Pradesh.Methods: The study was conducted in community health center of Sanwer Tehsil (Indore district) in the state of Madhya Pradesh in collaboration with the department of Community Medicine of Sri Aurobindo Medical College and PG Institute, Indore.Results: Out of 136 cases observed till completion, 66 cases were of female neonates and 70 cases were of male neonates. Out of 66 females, 36 cases (54.54%) were below the standard 2,500 g. Out of 70 male neonates, 44 cases were below the standard 2,500 g. Average female weight at time of birth was 2.1 kg while the average female height at time of birth was 46.48 cm. Average male weight at time of birth was 2.15 kg and average male height at time of birth was 47.37 cm.Conclusions: National programmes targeting to address low birth weight are the need of the hour.

Scaling-down mass ivermectin treatment for onchocerciasis elimination: modelling the impact of the geographical unit for decision making

Background Due to spatial heterogeneity in onchocerciasis transmission, the duration of ivermectin mass drug administration (MDA) required for eliminating onchocerciasis will vary within endemic areas and the occurrence of transmission ‘hotspots’ is inevitable. The geographical scale at which stop-MDA decisions are made will be a key driver in how rapidly national programmes can scale down active intervention upon achieving the epidemiological targets for elimination. Methods We use two onchocerciasis models (EPIONCHO-IBM and ONCHOSIM) to predict the likelihood of achieving elimination by 2030 in Africa, accounting for variation in pre-intervention endemicity levels and histories of ivermectin treatment. We explore how decision-making at contrasting geographical scales (community vs. larger scale ‘project’) changes projections on populations still requiring MDA or transitioning to post-treatment surveillance. Results The total population considered grows from 118 million people in 2020 to 136 million in 2030. If stop-MDA decisions are made at project level, the number of people requiring treatment declines from 69-118 million in 2020 to 59-118 million in 2030. If stop-MDA decisions are made at community level, the numbers decline from 23-81 million in 2020 to 15-63 million in 2030. The lower estimates in these predictions intervals are based on ONCHOSIM, the upper limits on EPIONCHO-IBM. Discussion/Conclusions The geographical scale at which stop-MDA decisions are made strongly determines how rapidly national onchocerciasis programmes can scale down MDA programmes. Stopping in portions of project areas or transmission zones would free up human and economic resources.

The Role of Adaptive Surveillance as a Core Intervention to Achieve Malaria Elimination

Adaptive surveillance systems are essential for national programmes to achieve their malaria elimination goals. Core principles of surveillance systems including accurate diagnosis and reporting of malaria cases, integration of health data across administrative levels and the need to link data to a response are well defined by international guidelines. Nevertheless, while the requirements of surveillance systems along the transmission continuum are clearly documented, the operationalization remains challenging for national programmes. Firstly, because the multi-level increase of surveillance efforts demanding real-time and case-based data as well as the capacity of the health force to trigger locally customized responses, is resource intensive and requires substantial investment. Secondly, because there is a gap in international alignment on best tools and practices on how to operationally implement these requirements. Recently, several initiatives have started to address this gap in international coordination, aiming to establish the operational guidance for elimination programmes to successfully implement adaptive surveillance systems.

The global procurement landscape of leishmaniasis medicines

Ensuring access to essential medicines for leishmaniasis control is challenging, as leishmaniasis is a very small and unattractive market for pharmaceutical industry. Furthermore, control programmes are severely underfunded. We conducted an analysis of global procurement of leishmaniasis medicines for the past 5 years in order to shed light on the current leishmaniasis market landscape and supply and demand dynamics. We estimated global demand of each leishmaniasis medicines, the amount of each medicine required to treat all reported cases, based on the number of cases reported to WHO and the first-line treatment regimen used in each country. Procurement data were obtained from procurement agencies, international organizations, WHO, national leishmaniasis programmes and manufacturers. Expert interviews were conducted to have a better understanding of how medicines were procured and used. The comparison of estimated need and procurement data indicated discrepancies in supply and demand at global level as well as in the most endemic countries. The extent of the gap in supply was up to 80% of the needs for one of the leishmaniasis medicines. Mismatch between supply and demand was much wider for cutaneous leishmaniasis than visceral leishmaniasis. This study presents a current picture of procurement patterns and imbalance in global supply and demand. Addressing improved access and supply barriers requires concerted and coordinated efforts at the global and national levels. Priority actions include setting up a procurement coordination mechanism among major procurers, partners and national programmes where forecasting and supply planning is jointly developed and communicated with manufacturers. In addition, continuous engagement of manufacturers and advocacy is critical to diversify the supplier base and ensure quality-assured and affordable generic medicines for leishmaniasis.