Perspectives of public health professionals on border control practices for COVID-19 management in Europe.

OBJECTIVES: During the COVID-19 pandemic, internal European borders were temporarily re-established to mitigate the outbreak. Much research on pandemic border control measures has focused on quantifying their effectiveness for infectious disease control as well as on their social consequences for cross-border life in the European Union. However, little attention has been paid to the impacts for the practice and organisation of cross-border public health. To address this gap, the present study analysed the experiences and perspectives of public health professionals working in European border regions regarding border control measures in the pandemic. STUDY DESIGN: Qualitative interview-based study. METHODS: In total, 27 semistructured interviews with public health professionals were conducted in the border regions between Germany, the Netherlands and Belgium. Participants were asked about their perspectives on border control and the spread of COVID-19 in the region. Interviews were performed between December 2020 and April 2021 and carried out in German, English, Dutch and French. RESULTS: Before the COVID-19 pandemic, borders had become largely invisible with extensive cross-border social life and mobility. Participants were sceptical about the role of cross-border mobility as a pandemic driver and consequently the effectiveness of enforcing border control for reducing the spread of COVID-19 in their border regions. At the same time, participants raised concerns about the negative consequences for the social fabric and provision of cross-border public health. CONCLUSIONS: Public health professionals highlighted the uncertain role of border control measures for regional infectious disease control in border regions. Rather than border control, sustainable cross-border communication and collaboration is crucial to ensure effective pandemic management in border regions.

Implementing a new antibiotic allergy protocol in clinical practice: well-trusted but not used.

BACKGROUND: Suboptimal antibiotic prescriptions in patients with an antibiotic allergy label lead to increased incidence of adverse events and antimicrobial resistance (AMR). An antibiotic allergy protocol was developed in a Dutch academic hospital guiding optimal and safe antibiotic use in potentially penicillin-allergic patients. Informed by previous studies of implementation processes in clinical care, we studied the implementation of this protocol. METHODS: Medical professionals in the Departments of Surgery, Internal Medicine, and Pulmonary Care were interviewed. Additionally, focus groups were conducted in Internal Medicine and Pulmonary Care to validate the outcomes of the interviews. RESULTS: Dissemination of the protocol via the regular online hospital-wide guidance system did not have a significant impact on the knowledge about or use of the protocol. If healthcare professionals found the protocol, they thought it was valuable and expressed trust in the expertise embodied in it. However, its use in practice was rather minimal. Interviewees doubted the accuracy of the patient's histories about their previous adverse drug reactions, and/or the information in their medical records and concluded that adherence to the expert guideline was needlessly risky. They felt the acute allergic reaction risk for a patient outweighed the risk of suboptimal therapy or future AMR. CONCLUSIONS: For successful implementation and dissemination of the protocol, the accessibility of the protocol, the information about the actual risks of following the protocol and the registration of allergic history should be improved. However, whether this actually results in improvement also depends on changes in the hospital culture and organization.

Complex narratives of health, stigma and control: Antimicrobial resistance screening among non-hospitalized refugees.

Antimicrobial resistance (AMR) is often presented as a major public health problem globally. Screening for AMR usually takes place in clinical settings. Recent developments in microbiology stimulated a series of studies focusing on AMR in communities, and particularly in travelers (any mobile individual), which was argued to be important for identifying potential public health risks. Against this background, microbiologists have become interested in non-hospitalized refugees as one of the traveler groups. However, this attention to refugees has provoked some professional debates on potential stigmatization of refugees as dangerous "others". To contribute to these debates, and to explore the idea of AMR screening of non-hospitalized refugees from different perspectives, we conducted a qualitative study among four groups of stakeholders who were chosen because of their associations with potential microbiological screening: microbiologists, public health physicians, public health nurses, and refugees. The study took place in a Dutch city from June to August 2016 and had 17 participants: five microbiologists, two public health nurses, four public health physicians, and six refugees. While microbiologists and public health physicians demonstrated a de-contextualized biomedical narrative in arguing that AMR screening among non-hospitalized refugees could be important for scientific research as well as for AMR prevention in communities, public health nurses displayed a more contextualized narrative bringing the benefits for individuals at the center and indicating that screening exclusively among refugees may provoke fear and stigmatization. Refugees were rather positive about AMR screening but stressed that it should particularly contribute to their individual health. We conclude that to design AMR prevention strategies, it is important to consider the complex meanings of AMR screening, and to design these strategies as a process of co-production by diverse stakeholders, including the target populations.

Drainage pits in cohesionless materials: implications for surface of Phobos.

Viking orbiter images show grooves and chains of pits crossing the surface of Phobos, many of which converge toward the large crater Stickney or its antipode. Although it has been proposed that the pits and grooves are chains of secondary craters, their morphology and geometric relations suggest that they are the surface traces of fractures in the underlying solid body of Phobos. Several models have been proposed to explain the pits, of which the most plausible are gas venting and drainage of regolith into open fractures. the latter mechanism is best supported by the image data and is the mechanism studied in this investigation. Drainage pits and fissures are modeled experimentally by using two rigid substrate plates placed edge to edge and covered by uniform thicknesses of dry fragmental debris (simulated regolith). Fracture extension is simulated by drawing the plates apart, allowing drainage of regolith into the newly created void. A typical drainage experiment begins with a shallow depression on the surface of the regolith, above the open fissure. Increased drainage causes local drainage pits to form; continued drainage causes the pits to coalesce, forming a cuspate groove. The resulting experimental patterns of pits and grooves have pronounced similarities to those observed on Phobos. Characteristics such as lack of raised rims, linearity of grooves and chains of pits, uniform spacing of pits, and progression from discrete pits to cuspate grooves are the same in the experiments and on Phobos. In contrast, gas-venting pits occur in irregular chains and have raised rims. These experiments thus indicate that the Phobos grooves and pits formed as drainage structures. The pit spacing in an experiment is measured at the time that the maximum number of pits forms, prior to groove development. The average pit spacing is compared to the regolith thickness for each material. Regression line fits indicate that the average spacing of drainage pits in unconsolidated, noncohesive regolith is nearly equal to the thickness of regolith and appears to gbe independent of the angle of repose, within the resolution of our experiments. This provides a simple means of estimating regolith thickness where drainage pits are present. On Phobos, two locations differing by 90 degrees in longitude have average pit spacings that suggest regolith thicknesses of 290 and 300 m, suggesting that large areas of Phobos have a nearly uniform regolith thickness of approximately 300 m.

Technology and the management of trust in insurance medicine.

This article deals with the question how technology contributed to the performing of objective assessments of health risks and to the public trust in the insurance institution. Many authors have pointed to the relevance of medical or statistical technology with regard to the constitution of objectivity, because these technologies should be capable of diminishing the influence of social interactions--the "human element"--on the process of producing knowledge about health risks. However, in this article it is shown that the constitution of objective risk assessments and public trust cannot be seen as the product of one particular type of technology, but that it is the product of a socio-technical network, in which several heterogeneous elements become interrelated and interdependant. The historical reconstruction of this network also sheds a new light on the role of 'the human element' in the constitution of objectivity and trust. It shows that elements in the network which regulate the social interaction between the subjects involved are of no less importance to generate trust than technologies which tend to abstract from this interaction. In other words, objective and subjective elements are intertwined much more than is often recognized, and public trust is to a fairly large degree depends on conventions in social interaction.