The 'missing' in the 'endgame' of hepatitis C elimination: A qualitative study in New South Wales, Australia.

INTRODUCTION: After a promising start in Australia, elimination efforts for hepatitis C are not on track. Following the global campaign to 'find the missing' in hepatitis C response, this qualitative study explores stakeholder perspectives on the 'missing' in the 'endgame' of hepatitis elimination in the state of New South Wales, Australia. METHOD: Twenty-eight key informants working in New South Wales, elsewhere in Australia and internationally in high income countries participated in a semi-structured qualitative interview. Analysis examined key informant accounts of the 'missing' in efforts to eliminate hepatitis C. RESULTS: Participants' accounts framed the missing in relation to epidemiological knowledge, making-up four population categories 'missing' or 'missed' in hepatitis C response. In turn, accounts situated the missing in relation to where and how individuals were presumed to connect, or not, with existing health-care infrastructures. This gave rise to concerns about the capacity of health services to be made available for those at risk or in need, with systems said to create opportunities for people to 'miss out' on hepatitis C services. DISCUSSION AND CONCLUSIONS: The 'missing' in the 'endgame' of hepatitis C elimination effort is not simply a function of who-populations missed-but of where and how, that is, situation and context. Our findings encourage a focus on how services, systems and contexts may create situations in which people become missed or are 'made missing' from care. We therefore advocate for a systemic, and not only population-based, approach in the final push towards hepatitis C's elimination.

Constitution of Long COVID illness, patienthood and recovery: a critical synthesis of qualitative studies.

OBJECTIVES: To investigate the lived experiences of Long COVID. DESIGN: Critical interpretive synthesis of qualitative research. DATA SOURCES: PubMed and Web of Science databases were searched on 14 September 2023. ELIGIBILITY CRITERIA: Original peer-reviewed qualitative studies describing the experiences of Long COVID were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS: We used established qualitative synthesis methods to search, screen and manually code the included studies. Critical interpretation methods were used to analyse the data and develop synthetic constructs. RESULTS: 68 articles were identified in the first phase of sampling, with 16 studies and 879 participants included in the final synthesis. The analysis of these studies was organised into three thematic constructions of Long COVID: (1) the illness, (2) the patient and (3) recovery. Long COVID was diversely characterised across study approaches, designs and findings but was underpinned by shared diagnostic logics, which shaped the identification and measurement of symptoms. The boundaries between different constitutions of Long COVID in qualitative accounts of illness experience were often imprecise. Slippages between different definitions of Long COVID had implications for patient experiences in relation to diagnosis, help-seeking and care, and expectations of recovery. CONCLUSIONS: Long COVID is a site of multiple and diverse qualitative interpretation. Accounts of lived experience emphasise the constitutions of illness, patienthood and recovery as situated and emergent. The ongoing context-based negotiation of Long COVID is a defining qualitative feature of the condition. Approaches to researching, diagnosing and developing health interventions must be as adaptive as the varieties of Long COVID lived experience.

In search of a 'good number': knowledge controversy and population estimates in the endgame of hepatitis C elimination.

We explore the contentious life of a metric used to assess a country's progress in relation to global disease elimination targets. Our topic is hepatitis C elimination, and our context is Australia. A fundamental metric in the calculation of progress toward hepatitis C elimination targets, as set by the WHO, is the population prevalence of people living with hepatitis C. In Australia, this modelled estimate has generated some controversy, largely through its repeated downsizing as an effect of calculus. The 2015 baseline population estimate in Australia, from which measures of current elimination progress are assessed, has reduced, over time, by around 30%. Informed by a social study of science approach, we used qualitative interviews with 32 experts to explore the knowledge controversy. The controversy is narrated through the core concerns of 'scale' and 'care', with narratives aligning differently to imaginaries of 'science' and 'community'. We trace how constitutions of 'estimate' and 'number' circulate in relation to 'population' and 'people', and as affective values. We show how enactments of estimates and numbers materialise hepatitis elimination in different ways, with policy implications. The event of the knowledge controversy opens up the social and political life of enumerations-for science and community-inviting deliberation on how to make 'good numbers' in the race to eliminate hepatitis C.

Exhausting care: On the collateral realities of caring in the early days of the Covid-19 pandemic.

We explore care as a site of multiplicity and tension. Working with the qualitative interview accounts of nineteen health care workers in Colombia, we trace a narrative of 'exhausting care' in the early days of the Covid-19 pandemic. Accounts relate exhausting care to working without break in response to extraordinary demand, heightened contagion concern, the pressures of caring in the face of anticipated death, and efforts to carry on caring in the face of constraint. We bring together the work of John Law (2010, 2011) on 'collateral realities' with Lauren Berlant's (2011) thesis of 'cruel optimism' to explore care as a site of practice in which the promise of the good can also become materialised as harm, given structural conditions. Through the reflexive narrative of 'carrying on' in the face of being 'worn down' by care, a narrative which runs through health care worker accounts, we draw attention to the collateral realities of exhausting care as personal and political, at once a practice of endurance and extraction. We argue that the exhausting care that relates to the extraordinariness of the Covid-19 pandemic also resides in the ordinariness, and slower violence, of the everyday. The cruel optimism of care is a relation in which the labour of care reproduces a harmful situation.

Navigating Chemical Toxicity in Coca Production in the Colombian Borderlands of Putumayo.

In Putumayo, a jungle borderland in southern Colombia, thousands of farmers derive their livelihood from the cultivation and processing of coca leaf, exposing themselves to fertilizers, pesticides, and other toxic chemicals on a daily basis. In this article, we show how the coca growers' relationship with chemicals and the health risks to which they are exposed, are politically and institutionally structured. We discuss the specific impact of anti-narcotics policy in a broader context of deep inequalities and document the emergent and adaptive day-to-day attempts of the farmers to navigate the structural risk environment.

Caring for coca, living with chemicals: Towards ecological harm reduction.

In this paper, we show how the materialisation of chemical harms linked to the cultivation of coca and its processing into coca paste reside in a wider politics of structural violence which is also situated ecologically. Drawing on the qualitative interview accounts of coca farmers in Putumayo, Colombia, we attend to practices of care in the field and in the laboratory. We look first at chemicals used in coca's cultivation (herbicides, fertilizers, pesticides), and second at chemicals (such as sulphuric acid, sodium carbonate, magnesium permanganate) used in the processing of coca leaf into paste (before the paste is sold on for refinement into cocaine). Our analysis highlights the tensions which inevitably arise in the balance and multiplicities of care - for crops, livelihood, and environment. We trace how farmers' narratives of the neutralisation of chemical risks habituate chemical harms as mundane, even uneventful, in an economic imperative to 'carry on as normal' in the coca economy. We emphasise health and harm as matters of care which not only affect humans but living environments. Accounts of 'risk environment' can give insufficient attention to Nature, and this leads us to consider 'ecological harm reduction'.

The fluid hospital: On the making of care environments in COVID-19.

This paper explores the boundary-making practices enacted by the hospital. Taking a hospital in Sydney, Australia, as our case, we investigate how the hospital holds together as a care environment through the coordinating movements of many materials, spaces, bodies, technologies, and affects. Drawing on interviews with hospital healthcare workers involved in care, research, and management related to COVID-19, we examine the multiplying effects of these movements to trace the ways in which the hospital is (re)made in relation with pandemic assemblages. We accentuate the material affordances of care environments and how care is adapted through the reshaping of the spaces and flows of the hospital. Through this, we highlight how care providers can work with the fluidity of the hospital, including through reorganizing routines and spaces of care, engaging with communication technologies to enact care at many scales, and remaking mundane materials as medical objects in the evolving care environment.

Understanding how PrEP is made successful: Implementation science needs an evidence-making approach.

After a decade of oral HIV pre-exposure prophylaxis (PrEP), the next generation of PrEP is being anticipated, including long-acting pills, injections, and implants. The unevenness of international PrEP implementation is increasingly recognised, with successful rollout in some settings and failure in others. There is a need to better understand conditions of PrEP implementation, and its localised (and sometimes unanticipated) effects. Implementation science explores how contexts and health systems shape the successful translation of health interventions. In this essay, we consider how PrEP is evolving and argue for an 'evidence-making' approach in relation to evidence and intervention translations. This approach emphasises how both interventions and their implementation contexts are co-constituted and evolve together. Unsettling the assumed universality of an intervention's effects and potential in relation to its implementation contexts helps to harness the localised possibilities for what PrEP might become. As the next generation of PrEP offers renewed promise, we must explore how PrEP is put to use and made to work in relation to its evolving situations. We urge implementation science to consider implementation processes as 'evidence-making events' in which evidence, intervention and context evolve together.

Dosing practices made mundane: Enacting HIV pre-exposure prophylaxis adherence in domestic routines.

Maintaining routines of medication dosing requires effort amidst the variabilities of everyday life. This article offers a sociomaterial analysis of how the oral HIV prevention regimen, pre-exposure prophylaxis (PrEP), is put to use and made to work, including in situations which disrupt or complicate dosing regimes. Other than a daily pill, PrEP can be taken less frequently based on anticipated sexual activity and HIV risk, including 'on-demand' and 'periodic' dosing. Drawing on 40 interviews with PrEP users in Australia in 2022, we explore PrEP and its dosing as features of assemblages in which bodies, routines, desires, material objects and the home environment interact. Dosing emerges as a practice of coordination involving dosette boxes, blister packs, alarms, partners, pets, planning sex, routines and domestic space, and as an effect of experimentations with timing to suit life circumstances and manage side effects. Dosing is materialised in the mundane; a practice that is made to work, as well as domesticated, in its situations. Although there are no 'simple' solutions to adherence, our analysis offers practical insights into how routine, planning and experimentation come together to capacitate PrEP to work in people's lives, in sometimes unexpected ways, including through adaptations of PrEP dosing.

Early warnings and slow deaths: A sociology of outbreak and overdose.

In this paper, we offer a sociological analysis of early warning and outbreak in the field of drug policy, focusing on opioid overdose. We trace how 'outbreak' is enacted as a rupturing event which enables rapid reflex responses of precautionary control, based largely on short-term and proximal early warning indicators. We make the case for an alternative view of early warning and outbreak. We argue that practices of detection and projection that help to materialise drug-related outbreaks are too focused on the proximal and short-term. Engaging with epidemiological and sociological work investigating epidemics of opioid overdose, we show how the short-termism and rapid reflex response of outbreak fails to appreciate the slow violent pasts of epidemics indicative of an ongoing need and care for structural and societal change. Accordingly, we gather together ideas of 'slow emergency' (Ben Anderson), 'slow death' (Lauren Berlant) and 'slow violence' (Rob Nixon), to re-assemble outbreaks in 'long view'. This locates opioid overdose in long-term attritional processes of deindustrialisation, pharmaceuticalisation, and other forms of structural violence, including the criminalisation and problematisation of people who use drugs. Outbreaks evolve in relation to their slow violent pasts. To ignore this can perpetuate harm. Attending to the social conditions that create the possibilities for outbreak invites early warning that goes 'beyond outbreak' and 'beyond epidemic' as generally configured.

Undoing elimination: Modelling Australia's way out of the COVID-19 pandemic.

In the middle of 2020, with its borders tightly closed to the rest of the world, Australia almost achieved the local elimination of COVID-19 and subsequently maintained 'COVID-zero' in most parts of the country for the following year. Australia has since faced the relatively unique challenge of deliberately 'undoing' these achievements by progressively easing restrictions and reopening. Exploring the role of mathematical modelling in navigating a course through the pandemic through qualitative interviews with modellers and others working closely with modelling, we argue that each of these two significant phases of Australia's COVID-19 experience can be understood as distinct forms of 'model society'. This refers at once to the society enacted through the governance of risk, and to the visions of societal outcomes - whether to be sought or to be avoided - that are offered up by models. Each of the two model societies came about through a reflexive engagement with risk facilitated by models, and the iterative relationship between the representations of society enacted within models and the possibilities that these representations generate in the material world beyond them.

Precarious Lives, Precarious Treatments: Making Drug Treatment Work in Northern Myanmar.

We explore how precarious livelihoods intersect with precarious treatments for heroin dependency in a setting affected by longstanding conflicts and an illicit drug economy as well as by recent events of pandemic and political change. Working with 33 qualitative interviews with people who inject drugs in Kachin State, northern Myanmar, we explore how drug dependency treatment, especially methadone substitution, is made to work in efforts to sustain everyday livelihoods. Our analysis attends to the work that is done to enable therapeutic trajectories to emerge as "generous constraints" in precarity. We trace methadone substitution as an emergent intervention of livelihood survival.

Escherichia coli expressing chloroplast chaperones as a proxy to test heterologous Rubisco production in leaves.

Rubisco is a fundamental enzyme in photosynthesis and therefore for life. Efforts to improve plant Rubisco performance have been hindered by the enzymes' complex chloroplast biogenesis requirements. New Synbio approaches, however, now allow the production of some plant Rubisco isoforms in Escherichia coli. While this enhances opportunities for catalytic improvement, there remain limitations in the utility of the expression system. Here we generate, optimize, and test a robust Golden Gate cloning E. coli expression system incorporating the protein folding machinery of tobacco chloroplasts. By comparing the expression of different plant Rubiscos in both E. coli and plastome-transformed tobacco, we show that the E. coli expression system can accurately predict high level Rubisco production in chloroplasts but poorly forecasts the biogenesis potential of isoforms with impaired production in planta. We reveal that heterologous Rubisco production in E. coli and tobacco plastids poorly correlates with Rubisco large subunit phylogeny. Our findings highlight the need to fully understand the factors governing Rubisco biogenesis if we are to deliver an efficient, low-cost screening tool that can accurately emulate chloroplast expression.

How do care environments shape healthcare? A synthesis of qualitative studies among healthcare workers during the COVID-19 pandemic.

OBJECTIVE: To investigate how care is shaped through the material practices and spaces of healthcare environments during the COVID-19 pandemic. DESIGN: Critical interpretive synthesis (CIS) of qualitative research. PARTICIPANTS: Studies included qualitative research investigating the experiences of healthcare workers involved in the care of individuals during the COVID-19 pandemic. RESULTS: 134 articles were identified in the initial sampling frame with 38 studies involving 2507 participants included in the final synthesis. Three themes were identified in the analysis: (1) the hospital transformed, (2) virtual care spaces and (3) objects of care. Through the generation of these themes, a synthesising argument was developed to demonstrate how material spaces and practices of healthcare shape care delivery and to provide insights to support healthcare providers in creating enabling and resilient care environments. CONCLUSIONS: The findings of this study demonstrate how healthcare environments enable and constrain modes of care. Practices of care are shaped through the materiality of spaces and objects, including how these change in the face of pandemic disruption. The implication is that the healthcare environment needs to be viewed as a critical adaptive element in the optimisation of care. The study also develops a versatile and coherent approach to CIS methods that can be taken up in future research.

Uncomfortable science: How mathematical models, and consensus, come to be in public policy.

We explore messy translations of evidence in policy as a site of 'uncomfortable science'. Drawing on the work of John Law, we follow evidence as a 'fluid object' of its situation, also enacted in relation to a hinterland of practices. Working with the qualitative interview accounts of mathematical modellers and other scientists engaged in the UK COVID-19 response, we trace how models perform as evidence. Our point of departure is a moment of controversy in the public announcement of second national lockdown in the UK, and specifically, the projected daily deaths from COVID-19 presented in support of this policy decision. We reflect on this event to trace the messy translations of "scientific consensus" in the face of uncertainty. Efforts among scientists to realise evidence-based expectation and to manage the troubled translations of models in policy, including via "scientific consensus", can extend the dis-ease of uncomfortable science rather than clean it up or close it down. We argue that the project of evidence-based policy is not so much in need of technical management or repair, but that we need to be thinking altogether differently.

Can a new formulation of opiate agonist treatment alter stigma?: Place, time and things in the experience of extended-release buprenorphine depot.

INTRODUCTION: Stigma has corrosive effects on all aspects of care and can undermine individual and population health outcomes. Addiction-related stigma has implications for opiate agonist treatment (OAT) and the people who receive, provide and fund it. It is important to understand how stigma is made in OAT and the political purposes that it serves, in order to change the relations of stigma and avoid the reproduction of stigma in the delivery of new treatment formulations, such as extended release buprenorphine (BUP-XR). METHODS: Semi-structured qualitative interviews were conducted at two time points with participants in a prospective single-arm, multicentre, open-label trial of monthly BUP-XR. Thirty-six participants (25 men, 11 women) were interviewed, and of these 32 participated in a second interview to explore their experience of transition from other treatment to BUP-XR. RESULTS: Participants were highly aware of the of the social and material effects of stigma through the negative stereotypes attached to OAT and those who receive it. Participants narrated examples of how stigma governed as a biopower in the relations and practices of OAT provision at numerous levels: structural (such as in public discourse about OAT and the people who receive it, in media, in perceptions about the decisions of investment in medical technologies); organisational (policies about legitimate access to OAT); interpersonal (with health workers) and individual (self-identities). BUP-XR allowed greater freedom and normalcy for clients. The experience of BUP-XR drew attention to the stigmatising potential of time, place and things associated with other OAT requiring daily (or frequent) dosing, accentuating how stigma comes to be materialised as a relational effect of everyday practices. CONCLUSIONS: Receiving BUP-XR allowed participants to avoid some of the everyday biopolitical powers of other forms of OAT and to reshape self-identities. The altering of relations between time, place and things associated with other forms of OAT allowed participants to feel as though they "pass as normal" . However, the negative public discourse and stigma of OAT is a potential threat to BUP-XR to realise its potential for individual and population benefits.

"A matter of time": Evidence-making temporalities of vaccine development in the COVID-19 media landscape.

This article investigates how evidence of the safety and efficacy of COVID-19 vaccines is enacted in news media via a focus on the temporality of vaccine development. We argue that time constitutes a crucial object of and mechanism for knowledge production in such media and investigate how time comes to matter in vaccine evidence-making communication practices. In science communication on vaccine development, the vaccine object (along with the practices through which it is produced) undergoes a material-discursive shift from an imagined "rushed" product to being many years in the making and uninhibited by unnecessarily lengthy processes. In both these enactments of vaccine development, time itself is constituted as evidence of vaccine efficacy and safety. This article traces how time (performed as both calendar time and as a series of relational events) is materialized as an affective and epistemic object of evidence within public science communication by analyzing the material-discursive techniques through which temporality is enacted within news media focused on the timeline of COVID-19 vaccine development. We contend that time (as evidence) is remade through these techniques as an ontopolitical concern within the COVID-19 vaccine assemblage. We furthermore argue that science communication itself is an important actor in the hinterland of public health practices with performative effects and vital evidence-making capacities.

Making pandemics big: On the situational performance of Covid-19 mathematical models.

In this paper, we trace how mathematical models are made 'evidence enough' and 'useful for policy'. Working with the interview accounts of mathematical modellers and other scientists engaged in the UK Covid-19 response, we focus on two weeks in March 2020 prior to the announcement of an unprecedented national lockdown. A key thread in our analysis is how pandemics are made 'big'. We follow the work of one particular device, that of modelled 'doubling-time'. By following how modelled doubling-time entangles in its assemblage of evidence-making, we draw attention to multiple actors, including beyond models and metrics, which affect how evidence is performed in relation to the scale of epidemic and its policy response. We draw attention to: policy; Government scientific advice infrastructure; time; uncertainty; and leaps of faith. The 'bigness' of the pandemic, and its evidencing, is situated in social and affective practices, in which uncertainty and dis-ease are inseparable from calculus. This materialises modelling in policy as an 'uncomfortable science'. We argue that situational fit in-the-moment is at least as important as empirical fit when attending to what models perform in policy.