Insight Healthcare

<title>Abstract</title> Global navigation satellite system (GNSS) positioning relies on accurate stochastic models for measurement errors to provide reliable position estimates and bounds. This paper presents a novel approach for modeling errors in GNSS measurements with Bayesian distributional regression, using variational inference to scale model complexity and data set size beyond typical computational limits. This methodology is applied to an automotive data set for GNSS pseudorange (multipath) errors, targeting a Student’s t-distributed model to realistically characterize heavy-tailed data. The distribution is regressed on signal quality indicators from the GNSS receiver to segment different environmental effects on the measurements. Bayesian penalized tensor product splines are used to model nonlinear relationships based on the signal quality indicators. Detailed analyses of goodness-of-fit diagnostics show that the model is able to fit well to the data, and model uncertainty is quantified such that users may be aware of and compensate for inaccuracies in modeling.

The National Health Service (NHS) in England provides funding for social prescribing to address the social determinants of ill-health. This paper describes a case study of how one general practice serving a disadvantaged population transitioned to Focused Care, a more intensive form of social prescribing, to increase engagement and improve outcomes. Characteristics of service users and their presenting problems, rates of engagement, resource implications of the service and potential benefits are discussed.

ABSTRACTBreastfeeding is the optimal method of infant and young child feeding. In Nigeria, breastfeeding rates have struggled to markedly improve over past decades. Prior efforts to understand the determinants of breastfeeding have heavily focused on women themselves, with lesser attention on the complex interplay of cultural, economic and health system factors affecting breastfeeding. Given the struggle to sustain improvements in optimal feeding practices, a deeper, updated understanding of the supportive environment for breastfeeding in Nigeria is needed. This subset analysis stems from a formative study that conducted semi‐structured interviews and focus group discussions in urban and rural communities in Nigeria's six geo‐political zones. The analysis explored barriers and facilitators to breastfeeding at different levels of a socioecological model (SEM). Discussions with pregnant women and mothers of young children focused on the supportive environment for breastfeeding beyond the individual level, exploring facilitators and barriers in women's nuclear and multi‐generational families, their communities, and institutions that provide health and nutrition services. At the household level, participants highlighted the influence of family elders. In their communities, widespread traditional practices and beliefs helped and hindered breastfeeding, along with varying sources of community‐level support and influence. At the service level, women elaborated on the effect of healthcare service access, service availability, and the quality of health and nutrition services. This formative analysis deepens understanding of factors crucial for developing multilevel and multicomponent interventions across the SEM in Nigeria that can simultaneously support mothers and improve infant health outcomes nationwide.

Nigerian pregnant and lactating women continue to experience high rates of malnutrition and Nigerian women experience long-term discrimination in the allocation and control of productive resources. Nigeria has policies and a governance architecture in place to advance nutrition, but these commitments lack recognition of how gender equity and nutrition are interwoven. To address this gap, this study sought to identify and analyze the influence of gender dynamics and gender norms on nutrition and health-related practices in Nigeria. This study used a combination of qualitative participatory activities and participant observation and questions to elicit information about the root causes of maternal, infant, and young child nutrition (MIYCN) and health concerns and typical nutrition and health practices in communities located across each of Nigeria's 6 geopolitical zones. This analysis was informed by social norms theory and sought evidence of gender norms, as well as related social sanctions and norms exceptions. Analysis of discussions with 503 participating men and women identified 3 overarching gender meta-norms that dictate women's mobility, gendered delineation of household tasks, and gendered decision-making and, therefore, in turn influence women's and men's engagement in recommended MIYCN behaviors such as involvement in production and purchasing of nutritious foods and seeking healthcare and nutrition counseling. Participants also described strong traditional gender ideologies and sanctions that uphold these restrictive norms. Encouragingly, participants described some exceptions to norms, which could indicate changing gender norms. Nigeria currently has one of the highest rates of acute food and nutrition insecurity in Africa and contends with persistent gender inequalities. Interventions are needed that more explicitly tackle the links between gender inequality and nutrition. This analysis revealed gender meta-norms, and related sanctions and exceptions that affect multiple MIYCN behaviors and offer potential entry points for community engagement, programming, and policy around these issues.

Despite recent advances in first-line therapies for multiple myeloma (MM), most patients relapse or become refractory, underscoring the need for effective second-line (2L) regimens for relapsed/refractory MM (RRMM). This study describes the real-world baseline characteristics, treatment patterns and clinical outcomes of adult patients diagnosed with MM between 2013 and 2020 using data collated by the National Cancer Registration and Analysis Service (NCRAS) of the National Health Service in England. The study cohorts were broadly aligned to the eligibility criteria of the ongoing DREAMM-7 (D7) and DREAMM-8 (D8) clinical trials. We focus on lenalidomide-exposed/refractory patients who received daratumumab-bortezomib-dexamethasone (DaraVd) at 2L in both cohorts. In the D7-like cohort, the lenalidomide-exposed (n=282) and lenalidomide-refractory (n=143) patients who received DaraVd at 2L had a median (95% confidence interval [CI]) time to next treatment or death (TTNTD) of 15.1 (12.6-22.4) and 10.3 (7.4-13.9) months, respectively. In the D8-like cohort, the lenalidomide-exposed (n=269) and lenalidomide-refractory (n=148) patients who received DaraVd at 2L had a median (95% CI) TTNTD of 14.5 (11.7-19.7) and 10.0 (7.3-13.7) months, respectively. Patients with RRMM in England receiving DaraVd at 2L have poor clinical outcomes, highlighting the urgent need for new therapies, particularly for lenalidomide-refractory patients.

Dietary intakes of omega-3 long chain polyunsaturated fatty acids (O3LC-PUFAs) such as eicosapentaenoic and docosahexaenoic acid are central to development and health across the life course. O3LC-PUFAs have been linked to neurological development, maternal and child health and the etiology of certain non-communicable diseases including age-related cognitive decline, cardiovascular disease, and diabetes. However, dietary inadequacies exist in the United Kingdom and on a wider global scale. One predominant dietary source of O3LC-PUFAs is fish and fish oils. However, growing concerns about overfishing, oceanic contaminants such as dioxins and microplastics and the trend towards plant-based diets appear to be acting as cumulative barriers to O3LC-PUFAs from these food sources. Microalgae are an alternative provider of O3LC-PUFA-rich oils. The delivery of these into food systems is gaining interest. The present narrative review aims to discuss the present barriers to obtaining suitable levels of O3LC-PUFAs for health and wellbeing. It then discusses potential ways forward focusing on innovative delivery methods to utilize O3LC-PUFA-rich oils including the use of fortification strategies, bioengineered plants, microencapsulation, and microalgae.