• f-Element silicon and heavy tetrel chemistry.

      Réant, Benjamin L L; orcid: 0000-0002-8137-5298; Liddle, Stephen T; orcid: 0000-0001-9911-8778; Mills, David P; orcid: 0000-0003-1575-7754 (2020-09-24)
      The last three decades have seen a significant increase in the number of reports of f-element carbon chemistry, whilst the f-element chemistry of silicon, germanium, tin, and lead remain underdeveloped in comparison. Here, in this perspective we review complexes that contain chemical bonds between f-elements and silicon or the heavier tetrels since the birth of this field in 1985 to present day, with the intention of inspiring researchers to contribute to its development and explore the opportunities that it presents. For the purposes of this perspective, f-elements include lanthanides, actinides and group 3 metals. We focus on complexes that have been structurally authenticated by single-crystal X-ray diffraction, and horizon-scan for future opportunities and targets in the area.
    • f-Element silicon and heavy tetrel chemistry.

      Réant, Benjamin L L; orcid: 0000-0002-8137-5298; Liddle, Stephen T; orcid: 0000-0001-9911-8778; Mills, David P; orcid: 0000-0003-1575-7754 (2020-09-24)
      The last three decades have seen a significant increase in the number of reports of f-element carbon chemistry, whilst the f-element chemistry of silicon, germanium, tin, and lead remain underdeveloped in comparison. Here, in this perspective we review complexes that contain chemical bonds between f-elements and silicon or the heavier tetrels since the birth of this field in 1985 to present day, with the intention of inspiring researchers to contribute to its development and explore the opportunities that it presents. For the purposes of this perspective, f-elements include lanthanides, actinides and group 3 metals. We focus on complexes that have been structurally authenticated by single-crystal X-ray diffraction, and horizon-scan for future opportunities and targets in the area. [Abstract copyright: This journal is © The Royal Society of Chemistry.]
    • Fabrication and Biological Assessment of Antidiabetic α-Mangostin Loaded Nanosponges: In Vitro, In Vivo, and In Silico Studies

      Usman, Faisal; orcid: 0000-0002-8998-9454; email: faisal.usman@bzu.edu.pk; Shah, Hamid Saeed; orcid: 0000-0003-4396-5235; email: hamid.saeed@uvas.edu.pk; Zaib, Sumera; email: sumera.zaib@ucp.edu.pk; Manee, Sirikhwan; email: sirikhwan.m@gmail.com; Mudassir, Jahanzeb; email: jahanzebmudassir@bzu.edu.pk; Khan, Ajmal; email: ajmalkhan@unizwa.edu.om; Batiha, Gaber El-Saber; orcid: 0000-0002-7817-425X; email: gaberbatiha@gmail.com; Abualnaja, Khamael M.; email: k.ala@tu.edu.sa; Alhashmialameer, Dalal; email: dsamer@tu.edu.sa; Khan, Imtiaz; orcid: 0000-0001-7359-1727; email: imtiaz.khan@manchester.ac.uk (MDPI, 2021-11-01)
      Type 2 diabetes mellitus has been a major health issue with increasing morbidity and mortality due to macrovascular and microvascular complications. The urgent need for improved methods to control hyperglycemic complications reiterates the development of innovative preventive and therapeutic treatment strategies. In this perspective, xanthone compounds in the pericarp of the mangosteen fruit, especially α-mangostin (MGN), have been recognized to restore damaged pancreatic β-cells for optimal insulin release. Therefore, taking advantage of the robust use of nanotechnology for targeted drug delivery, we herein report the preparation of MGN loaded nanosponges for anti-diabetic therapeutic applications. The nanosponges were prepared by quasi-emulsion solvent evaporation method. Physico-chemical characterization of formulated nanosponges with satisfactory outcomes was performed with Fourier transform infra-red (FTIR) spectroscopy, differential scanning calorimetry (DSC), and scanning electron microscopy (SEM). Zeta potential, hydrodynamic diameter, entrapment efficiency, drug release properties, and stability studies at stress conditions were also tested. Molecular docking analysis revealed significant interactions of α-glucosidase and MGN in a protein-ligand complex. The maximum inhibition by nanosponges against α-glucosidase was observed to be 0.9352 ± 0.0856 µM, 3.11-fold higher than acarbose. In vivo studies were conducted on diabetic rats and plasma glucose levels were estimated by HPLC. Collectively, our findings suggest that MGN-loaded nanosponges may be beneficial in the treatment of diabetes since they prolong the antidiabetic response in plasma and improve patient compliance by slowly releasing MGN and requiring less frequent doses, respectively.
    • Facilitating the social behaviour of bull elephants in zoos

      Hartley, M.; orcid: 0000-0001-7058-1400; Wood, A.; Yon, L. (Wiley, 2019-10-10)
    • Facilitators of probation-based domestic violence perpetrator programmes: ‘Who’s in the room?’

      Renehan, Nicole; orcid: 0000-0002-5674-7539; email: nicole.renehan@manchester.ac.uk (SAGE Publications, 2021-06-22)
      The role that probation practitioners play in the desistance process has begun to receive much needed attention. Yet, the experiences of facilitators of probation-based, domestic violence perpetrator programmes have long been neglected. This article explores the experiences and wellbeing of eight facilitators from one cohort of the Building Better Relationships (BBR) programme in England. Drawing upon five-months’ observations and in-depth interviews, I demonstrate how working with domestically violent men with insufficient knowledge, experience, or support, exacerbated within the context of Transforming Rehabilitation reforms, impacted significantly on facilitator well-being, professional identities, and practice. Practice implications are discussed.
    • Factors associated with carer psychological and physical health during end-of-life caregiving: an observational analysis of a population-based post-bereavement survey of carers of people with cancer.

      Grande, Gunn; orcid: 0000-0003-2200-1680; email: gunn.grande@manchester.ac.uk; Rowland, Christine; orcid: 0000-0001-8628-4638; Cotterill, Sarah; orcid: 0000-0001-5136-390X; Batistatou, Evridiki; Hanratty, Barbara; orcid: 0000-0002-3122-7190 (2021-10-29)
      Family caregivers play an essential role in end-of-life care but suffer considerable impact on their own health. A better understanding of main factors related to carers' health is important to inform interventions. The purpose of the study was to test for the first time the potential impact of a comprehensive set of observable variables on carer health during end-of-life caregiving within a population-based carer sample. National retrospective, cross-sectional, 4-month post-bereavement postal census survey of family carers of people who died from cancer. Relatives who registered a death from cancer during a 2-week period in England were identified from death certificates by the Office of National Statistics; response rate was 1504/5271 (28.5%). Carers' mental health was measured through General Health Questionnaire (GHQ)-12; general health was measured through EuroQoL EQ-Visual Analogue Scale (EQ-5D VAS). Survey questions to measure potential variables associated with carer health were based on past research and covered patients' symptoms and functioning; caregiving activities and hours; informal and formal help received; work hours, other caregiving, volunteering; changes to work, income and expenditure; sleep and relaxation; and demographic variables. Bivariate analyses and ordinary least square regression were performed to investigate these variables' relationship with outcomes. Patients' psychological symptoms and functioning, caregiving hours, female gender and self-sought formal help related to worse mental health. General practitioner and social care input and relaxation related to better mental health. Patients' psychological symptoms, caregiving hours and female gender were associated with worse general health, and older age, employment and relaxation were associated with better general health. Improvements in carers' health overall may be made by focusing on potential impacts of patients' psychological symptoms on carers, facilitating respite and relaxation, and paying particular attention to factors affecting female carers. [Abstract copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.]
    • Factors determining ultra-short-term survival and the commencement of active treatment in high-grade serous ovarian cancer: a case comparison study

      Hawarden, Amy; Russell, Bryn; Gee, Mary Ellen; Kayali, Fatima; Clamp, Andrew; Crosbie, Emma Jayne; Edmondson, Richard John; orcid: 0000-0003-2553-4423; email: richard.edmondson@manchester.ac.uk (BioMed Central, 2021-04-08)
      Abstract: Background: Despite improvements in median survival some patients with advanced ovarian cancer die within 100 days of diagnosis; the reasons for which remain poorly understood. Here we investigate if ultra short-term survival can be explained by patient characteristics or treatment pathways. Methods: A nested case comparison study was used to examine differences between patients with high grade serous ovarian/fallopian tube cancer who died within 100 days (n = 28) compared to a comparison group of patients matched for histology and including any survival greater than 100 days (n = 134). Results: Cases and comparison patients had similar ages, BMI, ACE-27, deprivation indices, and distribution of disease on CT. There were no significant delays in time to diagnosis or treatment (p = 0.68) between the groups. However, cases had lower serum albumin, haemoglobin and higher platelet counts than matched comparison patients (p < 0.0001) and a worse performance score (P = 0.006). Conclusion: Patients who die rapidly after a diagnosis of ovarian cancer are only slightly older and have similar pre treatment frailty compared to patients whose survival approaches the median. However they do appear to undergo greater physiological compromise as a result of their disease.
    • Factors determining ultra-short-term survival and the commencement of active treatment in high-grade serous ovarian cancer: a case comparison study

      Hawarden, Amy; Russell, Bryn; Gee, Mary Ellen; Kayali, Fatima; Clamp, Andrew; Crosbie, Emma Jayne; Edmondson, Richard John; orcid: 0000-0003-2553-4423; email: richard.edmondson@manchester.ac.uk (BioMed Central, 2021-04-08)
      Abstract: Background: Despite improvements in median survival some patients with advanced ovarian cancer die within 100 days of diagnosis; the reasons for which remain poorly understood. Here we investigate if ultra short-term survival can be explained by patient characteristics or treatment pathways. Methods: A nested case comparison study was used to examine differences between patients with high grade serous ovarian/fallopian tube cancer who died within 100 days (n = 28) compared to a comparison group of patients matched for histology and including any survival greater than 100 days (n = 134). Results: Cases and comparison patients had similar ages, BMI, ACE-27, deprivation indices, and distribution of disease on CT. There were no significant delays in time to diagnosis or treatment (p = 0.68) between the groups. However, cases had lower serum albumin, haemoglobin and higher platelet counts than matched comparison patients (p < 0.0001) and a worse performance score (P = 0.006). Conclusion: Patients who die rapidly after a diagnosis of ovarian cancer are only slightly older and have similar pre treatment frailty compared to patients whose survival approaches the median. However they do appear to undergo greater physiological compromise as a result of their disease.
    • Factors determining ultra-short-term survival and the commencement of active treatment in high-grade serous ovarian cancer: a case comparison study

      Hawarden, Amy; Russell, Bryn; Gee, Mary Ellen; Kayali, Fatima; Clamp, Andrew; Crosbie, Emma Jayne; Edmondson, Richard John; orcid: 0000-0003-2553-4423; email: richard.edmondson@manchester.ac.uk (BioMed Central, 2021-04-08)
      Abstract: Background: Despite improvements in median survival some patients with advanced ovarian cancer die within 100 days of diagnosis; the reasons for which remain poorly understood. Here we investigate if ultra short-term survival can be explained by patient characteristics or treatment pathways. Methods: A nested case comparison study was used to examine differences between patients with high grade serous ovarian/fallopian tube cancer who died within 100 days (n = 28) compared to a comparison group of patients matched for histology and including any survival greater than 100 days (n = 134). Results: Cases and comparison patients had similar ages, BMI, ACE-27, deprivation indices, and distribution of disease on CT. There were no significant delays in time to diagnosis or treatment (p = 0.68) between the groups. However, cases had lower serum albumin, haemoglobin and higher platelet counts than matched comparison patients (p < 0.0001) and a worse performance score (P = 0.006). Conclusion: Patients who die rapidly after a diagnosis of ovarian cancer are only slightly older and have similar pre treatment frailty compared to patients whose survival approaches the median. However they do appear to undergo greater physiological compromise as a result of their disease.
    • Factors Limiting Subgroup Analysis in Cost-Effectiveness Analysis and a Call for Transparency.

      Shields, Gemma E; orcid: 0000-0003-4869-7524; email: gemma.shields@manchester.ac.uk; Wilberforce, Mark; orcid: 0000-0001-6977-4483; Clarkson, Paul; orcid: 0000-0002-0778-312X; Farragher, Tracey; orcid: 0000-0002-1968-6378; Verma, Arpana; orcid: 0000-0002-7950-2649; Davies, Linda M; orcid: 0000-0001-8801-3559 (2021-10-29)
      The use of population averages in cost-effectiveness analysis may hide important differences across subgroups, potentially resulting in suboptimal resource allocation, reduced population health and/or increased health inequalities. We discuss the factors that limit subgroup analysis in cost-effectiveness analysis and propose more thorough and transparent reporting. There are many issues that may limit whether subgroup analysis can be robustly included in cost-effectiveness analysis, including challenges with prespecifying and justifying subgroup analysis, identifying subgroups that can be implemented (identified and targeted) in practice, resource and data requirements, and statistical and ethical concerns. These affect every stage of the design, development and reporting of cost-effectiveness analyses. It may not always be possible to include and report relevant subgroups in cost effectiveness, e.g. due to data limitations. Reasons for not conducting subgroup analysis may be heterogeneous, and the consequences of not acknowledging patient heterogeneity can be substantial. We recommend that when potentially relevant subgroups have not been included in a cost-effectiveness analysis, authors report this and discuss their rationale and the limitations of this. Greater transparency of subgroup reporting should provide a starting point to overcoming these challenges in future research. [Abstract copyright: © 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.]
    • FAK inhibition alone or in combination with adjuvant therapies reduces cancer stem cell activity

      Timbrell, Simon; Aglan, Hosam; Cramer, Angela; Foden, Phil; Weaver, David; Pachter, Jonathan; Kilgallon, Aoife; Clarke, Robert B.; Farnie, Gillian; email: gillian.farnie@ndorms.ox.ac.uk; Bundred, Nigel J.; orcid: 0000-0001-6007-056X; email: Bundredn@manchester.ac.uk (Nature Publishing Group UK, 2021-05-28)
      Abstract: Cancer stem-like cells (CSC) contribute to therapy resistance and recurrence. Focal adhesion kinase (FAK) has a role in CSC regulation. We determined the effect of FAK inhibition on breast CSC activity alone and in combination with adjuvant therapies. FAK inhibition reduced CSC activity and self-renewal across all molecular subtypes in primary human breast cancer samples. Combined FAK and paclitaxel reduced self-renewal in triple negative cell lines. An invasive breast cancer cohort confirmed high FAK expression correlated with increased risk of recurrence and reduced survival. Co-expression of FAK and CSC markers was associated with the poorest prognosis, identifying a high-risk patient population. Combined FAK and paclitaxel treatment reduced tumour size, Ki67, ex-vivo mammospheres and ALDH+ expression in two triple negative patient derived Xenograft (PDX) models. Combined treatment reduced tumour initiation in a limiting dilution re-implantation PDX model. Combined FAK inhibition with adjuvant therapy has the potential to improve breast cancer survival.
    • FAK inhibition alone or in combination with adjuvant therapies reduces cancer stem cell activity.

      Timbrell, Simon; Aglan, Hosam; Cramer, Angela; Foden, Phil; Weaver, David; Pachter, Jonathan; Kilgallon, Aoife; Clarke, Robert B; Farnie, Gillian; email: gillian.farnie@ndorms.ox.ac.uk; Bundred, Nigel J; orcid: 0000-0001-6007-056X; email: bundredn@manchester.ac.uk (2021-05-28)
      Cancer stem-like cells (CSC) contribute to therapy resistance and recurrence. Focal adhesion kinase (FAK) has a role in CSC regulation. We determined the effect of FAK inhibition on breast CSC activity alone and in combination with adjuvant therapies. FAK inhibition reduced CSC activity and self-renewal across all molecular subtypes in primary human breast cancer samples. Combined FAK and paclitaxel reduced self-renewal in triple negative cell lines. An invasive breast cancer cohort confirmed high FAK expression correlated with increased risk of recurrence and reduced survival. Co-expression of FAK and CSC markers was associated with the poorest prognosis, identifying a high-risk patient population. Combined FAK and paclitaxel treatment reduced tumour size, Ki67, ex-vivo mammospheres and ALDH+ expression in two triple negative patient derived Xenograft (PDX) models. Combined treatment reduced tumour initiation in a limiting dilution re-implantation PDX model. Combined FAK inhibition with adjuvant therapy has the potential to improve breast cancer survival.
    • Falls risk is predictive of dysphagia in Parkinson's disease.

      Kobylecki, Christopher; orcid: 0000-0002-7797-0756; email: christopher.kobylecki@manchester.ac.uk; Shiderova, Irena; Boca, Mihaela; Michou, Emilia; orcid: 0000-0002-7245-0882 (2021-11-03)
      Evaluate the relationship between falls, freezing of gait, and swallowing disturbance in Parkinson's disease (PD). Dysphagia is a common symptom in PD, and is often thought of as an axial feature along with falls and gait disturbance. It is of interest to examine the relationship between these symptoms in PD, given the possibility of shared pathophysiology due to non-dopaminergic and extranigral dysfunction. We recruited 29 consecutive non-demented patients with idiopathic PD and at least one clinically determined impairment in swallowing, falls, or freezing of gait. Swallow dysfunction was assessed using the Swallowing Disturbance Questionnaire (SDQ). The Falls Efficacy Scale and Freezing-of-gait questionnaire were recorded. Correlation analysis and multiple regression were used to determine the relationship between swallow and gait disturbance. Total SDQ score correlated strongly with the falls efficacy scale (Spearman's rho = 0.594; P = 0.001), but not with the freezing-of-gait score. Linear regression controlling for other factors associated with dysphagia identified falls efficacy score as a significant predictor of swallow dysfunction. The severity of dysphagia in PD is closely related to severity of falls, but not gait freezing. This may be helpful to more precisely determine the anatomical substrate of levodopa-resistant axial symptoms in PD and provide clues to further management. [Abstract copyright: © 2021. The Author(s).]
    • Fanconi Anaemia, Childhood Cancer and the BRCA Genes

      Woodward, Emma R.; orcid: 0000-0002-6297-2855; email: stefan.meyer@manchester.ac.uk; Meyer, Stefan; orcid: 0000-0002-2283-3690; email: emma.woodward@mft.nhs.uk (MDPI, 2021-09-27)
      Fanconi anaemia (FA) is an inherited chromosomal instability disorder characterised by congenital and developmental abnormalities and a strong cancer predisposition. In less than 5% of cases FA can be caused by bi-allelic pathogenic variants (PGVs) in BRCA2/FANCD1 and in very rare cases by bi-allelic PGVs in BRCA1/FANCS. The rarity of FA-like presentation due to PGVs in BRCA2 and even more due to PGVs in BRCA1 supports a fundamental role of the encoded proteins for normal development and prevention of malignant transformation. While FA caused by BRCA1/2 PGVs is strongly associated with distinct spectra of embryonal childhood cancers and AML with BRCA2-PGVs, and also early epithelial cancers with BRCA1 PGVs, germline variants in the BRCA1/2 genes have also been identified in non-FA childhood malignancies, and thereby implying the possibility of a role of BRCA PGVs also for non-syndromic cancer predisposition in children. We provide a concise review of aspects of the clinical and genetic features of BRCA1/2-associated FA with a focus on associated malignancies, and review novel aspects of the role of germline BRCA2 and BRCA1 PGVs occurring in non-FA childhood cancer and discuss aspects of clinical and biological implications.
    • Fecal Glucocorticoid Metabolites as Biomarkers in Equids: Assay Choice Matters

      Hinchcliffe, Danielle L.; orcid: 0000-0001-5204-5161; Lea, Jessica M. D.; Palme, Rupert; orcid: 0000-0001-9466-3662; Shultz, Susanne; orcid: 0000-0002-7135-4880; email: Susanne.shultz@manchester.ac.uk (2021-06-01)
      ABSTRACT: Free ranging animals are exposed to environmental, demographic, and ecological challenges over time, which can affect their health and fitness. Non‐invasive biomarkers can provide insight into how animals cope with these challenges and assess the effectiveness of conservation management strategies. We evaluated how free ranging ponies (Equus ferus caballus) on the Carneddau Mountain range, North Wales respond to 2 stimuli: an acute stressor of an annual roundup event in November 2014, and spatial and temporal variation in ecological factors in 2018. We evaluated fecal glucocorticoid metabolites using 2 enzyme immunoassays (EIAs): an 11‐oxoetiocholanolone EIA (measuring 11,17‐dioxoandrostanes [11,17‐DOAs]) and a corticosterone EIA. The former assay has been validated in equids, whereas there is limited evidence for the suitability of the latter. We used an additional parent testosterone EIA to measure fecal androgen metabolites in response to the ecological challenges. Following the roundup, the metabolite concentrations measured by the 2 glucocorticoid EIAs were not correlated. The 11,17‐DOAs were elevated from the second day following the roundup and then slowly returned to pre‐round levels over the next 2 weeks. In contrast, the metabolites measured by the corticosterone assay showed no response to the roundup. For the ecological data, all 3 assays detected a positive correlation between metabolites and social group size in males but not in females. The metabolite concentrations measured by the testosterone and corticosterone assays were highly correlated and were temporally associated with the onset of the breeding season, whereas the 11,17‐DOAs were not. The co‐variance of metabolites measured by the corticosterone and testosterone assays, and the lack of an acute response in the corticosterone assay to the roundup, suggests that metabolites detected by the corticosterone assay were not primarily associated with increased glucocorticoid production. We recommend using well‐validated fecal biomarker assays of hypothalamus‐pituitary‐adrenal axis activity to evaluate and compare the effect of different management interventions and environmental change. © 2021 The Authors. The Journal of Wildlife Management published by Wiley Periodicals LLC on behalf of The Wildlife Society.
    • Fiber Surface/Interfacial Engineering on Wearable Electronics

      Xiao, Ruimin; Yu, Guiqin; Xu, Ben Bin; email: BEN.XU@NORTHUMBRIA.AC.UK; email: xuqing.liu@postgrad.manchester.ac.uk; Wang, Nan; Liu, Xuqing; orcid: 0000-0001-5998-6546; email: xuqing.liu@postgrad.manchester.ac.uk (2021-08-21)
      Abstract: Surface/interfacial engineering is an essential technique to explore the fiber materials properties and fulfil new functionalities. An extensive scope of current physical and chemical treating methods is reviewed here together with a variety of real‐world applications. Moreover, a new surface/interface engineering approach is also introduced: self‐assembly via π–π stacking, which has great potential for the surface modification of fiber materials due to its nondestructive working principle. A new fiber family member, metal‐oxide framework (MOF) fiber shows promising candidacy for fiber based wearable electronics. The understanding of surface/interfacial engineering techniques on fiber materials is advanced here and it is expected to guide the rational design of future fiber based wearable electronics.
    • Fibroblast Growth Factor Receptors (FGFRs) and Noncanonical Partners in Cancer Signaling

      Ferguson, Harriet R.; email: harriet.ferguson-2@postgrad.manchester.ac.uk; Smith, Michael P.; orcid: 0000-0002-5980-7840; email: michael.smith-8@manchester.ac.uk; Francavilla, Chiara; orcid: 0000-0003-1775-3386; email: chiara.francavilla@manchester.ac.uk (MDPI, 2021-05-14)
      Increasing evidence indicates that success of targeted therapies in the treatment of cancer is context-dependent and is influenced by a complex crosstalk between signaling pathways and between cell types in the tumor. The Fibroblast Growth Factor (FGF)/FGF receptor (FGFR) signaling axis highlights the importance of such context-dependent signaling in cancer. Aberrant FGFR signaling has been characterized in almost all cancer types, most commonly non-small cell lung cancer (NSCLC), breast cancer, glioblastoma, prostate cancer and gastrointestinal cancer. This occurs primarily through amplification and over-expression of FGFR1 and FGFR2 resulting in ligand-independent activation. Mutations and translocations of FGFR1-4 are also identified in cancer. Canonical FGF-FGFR signaling is tightly regulated by ligand-receptor combinations as well as direct interactions with the FGFR coreceptors heparan sulfate proteoglycans (HSPGs) and Klotho. Noncanonical FGFR signaling partners have been implicated in differential regulation of FGFR signaling. FGFR directly interacts with cell adhesion molecules (CAMs) and extracellular matrix (ECM) proteins, contributing to invasive and migratory properties of cancer cells, whereas interactions with other receptor tyrosine kinases (RTKs) regulate angiogenic, resistance to therapy, and metastatic potential of cancer cells. The diversity in FGFR signaling partners supports a role for FGFR signaling in cancer, independent of genetic aberration.
    • Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa

      Wong, Anabelle; orcid: 0000-0002-5421-8692; email: anabellewong.hk@gmail.com; Hung, Kevin K. C.; orcid: 0000-0001-8706-7758; email: kevin.hung@cuhk.edu.hk; Mabhala, Mzwandile; orcid: 0000-0003-1350-7065; email: a.mabhala@chester.ac.uk; Tenney, Justin W.; email: jtenney@westcoastuniversity.edu; Graham, Colin A.; orcid: 0000-0002-4381-7470; email: cagraham@cuhk.edu.hk (MDPI, 2021-07-31)
      Background: While the pharmacy workforce is the third largest professional healthcare group worldwide, the pharmacy workforce landscape remains unclear in post-conflict areas in sub-Saharan Africa. Method: Key informants were selected for semi-structured interviews due to their role in providing pharmacy services in the selected country: the Central African Republic (CAR), the Democratic Republic of Congo (DRC), Ethiopia, and South Sudan. Transcripts from the interviews were anonymized, coded, and analyzed. Results: Nine participants were recruited (CAR: 2; DRC: 2; Ethiopia: 2; South Sudan: 3), and all except two were pharmacists. Conflict-specific challenges in pharmacy service delivery were identified as the following: unpredictable health needs and/or mismatched pharmaceutical supply, transport difficulties due to insecure roads, and shortage of pharmacy workforce due to brain drain or interrupted schooling. Barriers to health workforce retention and growth were identified to be brain drain as a result of suboptimal living and working conditions or remuneration, the perception of an unsafe work environment, and a career pathway or commitment duration that does not fit the diaspora or expatriate staff. Conclusion: To tackle the barriers of pharmacy health workforce retention and growth, policy solutions will be required and efforts that can bring about long-term improvement should be prioritized. This is essential to achieve universal health coverage and the targets of the sustainable development goals for conflict affected areas, as well as to “leave no one behind”.
    • Filling the Gaps in the Pharmacy Workforce in Post-Conflict Areas: Experience from Four Countries in Sub-Saharan Africa.

      Wong, Anabelle; orcid: 0000-0002-5421-8692; Hung, Kevin K C; orcid: 0000-0001-8706-7758; Mabhala, Mzwandile; orcid: 0000-0003-1350-7065; Tenney, Justin W; Graham, Colin A; orcid: 0000-0002-4381-7470 (2021-07-31)
      While the pharmacy workforce is the third largest professional healthcare group worldwide, the pharmacy workforce landscape remains unclear in post-conflict areas in sub-Saharan Africa. Key informants were selected for semi-structured interviews due to their role in providing pharmacy services in the selected country: the Central African Republic (CAR), the Democratic Republic of Congo (DRC), Ethiopia, and South Sudan. Transcripts from the interviews were anonymized, coded, and analyzed. Nine participants were recruited (CAR: 2; DRC: 2; Ethiopia: 2; South Sudan: 3), and all except two were pharmacists. Conflict-specific challenges in pharmacy service delivery were identified as the following: unpredictable health needs and/or mismatched pharmaceutical supply, transport difficulties due to insecure roads, and shortage of pharmacy workforce due to brain drain or interrupted schooling. Barriers to health workforce retention and growth were identified to be brain drain as a result of suboptimal living and working conditions or remuneration, the perception of an unsafe work environment, and a career pathway or commitment duration that does not fit the diaspora or expatriate staff. To tackle the barriers of pharmacy health workforce retention and growth, policy solutions will be required and efforts that can bring about long-term improvement should be prioritized. This is essential to achieve universal health coverage and the targets of the sustainable development goals for conflict affected areas, as well as to "leave no one behind".