Re-examining critiques of resilience policy: evidence from Barpak after the 2015 earthquake in Nepal.

This paper examines three common critiques of 'resilience': (i) that it is a 'top-down' policy discourse that pays too little regard to local specificities; (ii) that resilience policy represents a neoliberal shift towards the responsibilisation of communities and a retreat of the state from its role in providing protection; and (iii) that the focus on resilience tends to divert attention from the underlying causes of vulnerability. Using data collected after the 2015 earthquake in Nepal, the paper argues that these critiques have mixed salience in this context, but that (i) and (iii) in particular point to important problems in how the central government and its international partners have approached enhancing the resilience of communities. While there are benefits to considering resilience at the local level, it is important to recognise the inequalities within communities, how these might be reflected in differential degrees of vulnerability, and how they might be reinforced through resilience-building programmes.

Methods for living guidelines: early guidance based on practical experience. Paper 3: selecting and prioritizing questions for living guidelines.

OBJECTIVES: This article is part of a series on methods for living guidelines, consolidating practical experiences from developing living guidelines. It focuses on methods for identification, selection, and prioritization of clinical questions for a living approach to guideline development. STUDY DESIGN AND SETTING: Members of the Australian Living Evidence Consortium, the National Institute of Health and Care Excellence and the US Grading of Recommendations, Assessment, Development and Evaluations Network, convened a working group. All members have expertize and practical experience in the development of living guidelines. We collated methods, documents on prioritization from each organization's living guidelines, conducted interviews and held working group discussions. We consolidated these to form best practice principles which were then edited and agreed on by the working group members. RESULTS: We developed best practice principles for (1) identification, (2) selection, and (3) prioritization, of questions for a living approach to guideline development. Several different strategies for undertaking prioritizing questions are explored. CONCLUSION: The article provides guidance for prioritizing questions in living guidelines. Subsequent articles in this series explore consumer involvement, search decisions, and methods decisions that are appropriate for questions with different priority levels.

Challenges in applying the GRADE approach in public health guidelines and systematic reviews: a concept article from the GRADE Public Health Group.

BACKGROUND AND OBJECTIVE: This article explores the need for conceptual advances and practical guidance in the application of the GRADE approach within public health contexts. METHODS: We convened an expert workshop and conducted a scoping review to identify challenges experienced by GRADE users in public health contexts. We developed this concept article through thematic analysis and an iterative process of consultation and discussion conducted with members electronically and at three GRADE Working Group meetings. RESULTS: Five priority issues can pose challenges for public health guideline developers and systematic reviewers when applying GRADE: (1) incorporating the perspectives of diverse stakeholders; (2) selecting and prioritizing health and "nonhealth" outcomes; (3) interpreting outcomes and identifying a threshold for decision-making; (4) assessing certainty of evidence from diverse sources, including nonrandomized studies; and (5) addressing implications for decision makers, including concerns about conditional recommendations. We illustrate these challenges with examples from public health guidelines and systematic reviews, identifying gaps where conceptual advances may facilitate the consistent application or further development of the methodology and provide solutions. CONCLUSION: The GRADE Public Health Group will respond to these challenges with solutions that are coherent with existing guidance and can be consistently implemented across public health decision-making contexts.

Commencing Nutrient Supplements before Full Enteral Feed Volume Achievement Is Beneficial for Moderately Preterm to Late Preterm Low Birth Weight Babies: A Prospective, Observational Study.

The aim of this study was to observe after following a routine change in the feeding protocol whether the earlier introduction of nutrient supplements improved nutritional outcomes in moderately preterm to late preterm low birth weight (LBW) babies. In this prospective observational study, LBW babies between 31 and 39 weeks' gestation admitted to a Special Care Nursery were assigned to two groups (F80, n = 45, F160, n = 42) upon commencing nutrient supplement at total fluid intake achievement of 80 or 160 mL/kg/day. Outcomes included weight, protein intake, biochemical markers, feeding intolerance, and length of stay (LOS). F80 nutrient supplements commenced before F160 (2.8 vs. 6.7 days, p < 0.0001) and lasted longer (15.2 vs. 12.2 days, p < 0.03). Weight gain velocity and LOS were similar. F80 mean protein intake during the first 10 days was higher (3.38 vs. 2.74 g/kg/day, p < 0.0001). There were fewer infants with protein intake <3 g/kg/day in the F80 group (8% vs. 65%, p < 0001). F80 babies regained birthweight almost two days earlier (7.5 vs. 9.4 days, p < 0.01). Weight gain Z-scores revealed an attenuation of the trend towards lower weight percentiles in the F80 group. Feeding intolerance was decreased for F80 (24.4% vs. 47.6%, p < 0.03). There were no adverse outcomes. Earlier nutrient supplementation for LBW babies lifts mean protein intake to above 3 g/kg/day and reduces both the duration of post-birth weight loss and incidence of feeding intolerance.

Use of information and communication technologies in the formal and informal health system responses to the 2015 Nepal earthquakes.

Information and Communication Technologies (ICTs) are increasingly recognized for their potential contributions to health service delivery in Low-and Middle-Income Countries (LMICs). As well as playing a role in improving the provision of health services under everyday 'normal' circumstances, ICTs can also be important in preparing for, mitigating, responding to and recovering from disasters. This research explores the use of ICTs in a natural disaster situation in Nepal, a country affected by a series of strong earthquakes in 2015. In March and April 2016, in-depth semi-structured interviews (n = 24) and focus group discussions (n = 4) were conducted with key informants: those affected by the earthquake, and those forming part of the formal or informal health system responses. Data were collected and analysed across three levels, from the bottom 'upwards', namely: (1) village level; (2) district level and (3) central/national level. Perceptions of the role and value of ICTs varied greatly-as did patterns of use. While access and capability were found to be key barriers to use rurally, ICTs were nevertheless an important part of the informal response, helping people to gather information, express needs and cope emotionally. They also helped relief agencies in allowing for networking and coordination among actors. Use of ICTs in the formal health system response, however, was severely lacking in many areas, relying more on traditional methods of disaster management. This reflects a general deficiency in, and underuse of, ICTs in the pre-earthquake Nepali healthcare system. We conclude by calling for a redoubling of efforts to improve and increase the adoption, diffusion, integration and regular use of ICTs within the Nepali health system-an approach that will assist with day-to-day service delivery but also provide a crucial platform upon which to build during future crises.