Robert Fraser Terry

Objectives Enabling the reuse of participant-level health data is central to advancing public health and clinical practice. Measuring knowledge, attitudes and practices (KAP) related to data sharing is essential for understanding how stakeholders perceive data reuse and where further investment is needed. We conducted a measurement systematic review to identify and describe the development, scope and measurement properties of quantitative surveys assessing data-sharing-related KAP in biomedical research. Design Systematic review using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) approach. Data sources Ovid (MEDLINE), EMBASE, CINAHL, PsycINFO and HaPI were searched for relevant surveys from 1 January 2000 to 7 April 2021. The Ovid (MEDLINE) search was updated on 30 May 2022 and 15 April 2024. Eligibility criteria Quantitative surveys measuring knowledge, attitudes, behaviours or practices related to sharing or reusing participant-level health data were included. Data extraction and synthesis Two independent reviewers screened studies, extracted data and, where possible, applied the COSMIN Risk of Bias checklist to assess survey measurement properties. We summarised survey scope, target populations, data types, development and measurement properties narratively. Due to substantial heterogeneity, survey findings were not compared across studies. Results We screened 3684 title-abstracts, reviewed 104 full texts and extracted data from 72 publications representing 60 independent surveys. Most surveys originated from high-income countries and were used only once. Fewer than one-third reported pilot testing. Only six surveys provided sufficient information to apply COSMIN, and only three reported measurement properties, indicating low certainty in the available evidence. Conclusions This is the first systematic comparison of the development and measurement properties of quantitative survey instruments assessing data-reuse KAP. Most surveys lacked rigorous development and reporting, limiting their utility for comparing KAP related to data sharing across stakeholders and settings. The review findings will inform the creation of a cross-country, cross-disciplinary question bank to support future tool development. PROSPERO registration number CRD42021243926.

Antimicrobial resistance (AMR) can disseminate through effluents from seafood processing facilities (SPFs), posing environmental and public health risks. This study assessed changes in coliform load and antimicrobial resistance patterns in effluents from two SPFs in Tema, Ghana, before and after upgrades to effluent treatment systems between 2022 and 2024. A total of 19 effluent samples were collected per SPF in 2021–2022, 20 effluent samples each per SPF in 2024, and 8 potable water samples each per SPF in 2024. Median coliform counts declined significantly in both facilities (SPF-1: 920 to 35 MPN/100 mL; SPF-2: 280 to 9.5 MPN/100 mL; p < 0.001), representing a 96% overall reduction. Escherichia coli prevalence decreased markedly in SPF-2, although Pseudomonas aeruginosa emerged after treatment upgrades. Resistance to third-generation cephalosporins and multidrug resistance declined, particularly in SPF-1, but persisted across both facilities. Potable water used for seafood processing showed low but detectable coliform contamination. Despite substantial reductions in coliform bacterial load, the continued presence of resistant gram-negative bacteria highlights the need for sustained AMR surveillance, mandatory effective effluent treatment, and routine disinfection of potable water to protect public health.

Background The coronavirus disease 2019 (COVID-19) has caused substantial morbidity and mortality on a global scale. A strong correlation has been found between COVID-19 treatment outcomes and noncommunicable diseases such as cancers. However, there is limited information on the outcomes of cancer patients who were hospitalised for COVID-19. Methods We conducted an analysis on data collected in a large prospective cohort study set-up by the World Health Organisation (WHO) International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). All patients with laboratory-confirmed or clinically-diagnosed SARS-CoV-2 infection were included. Cancer was defined as having a current solid organ or haematological malignancy. The following outcomes were assessed; The hazard ratio of 30-day in-hospital mortality, intensive care unit (ICU) admission, length of hospitalization and receipt of higher-level care. Results Of the 560,547 hospitalised individuals who were analysed, 27,243 (4.9%) had cancer. Overall, cancer patients were older and had more comorbidities than non-cancer patients. Patients with cancer had a higher hazard ratio of 30-day in-hospital mortality than non-cancer patients (29.1.3% vs 18.0%) and longer hospital stays (median of 12 days vs 8 days). However, patients with cancer were admitted less often to intensive care units than non-cancer patients (12.6% vs 17.1%) and received less invasive mechanical ventilation than non-cancer patients (4.5% vs 7.6%). The hazard ratio of dying from cancer, adjusted for age, sex and country income level was 1.18 (95%CI: 1.15-1.2). Conclusions This study’s findings underscore the heightened vulnerability of hospitalized COVID-19 patients with cancer, revealing a higher mortality rate, longer hospital stays, and an unstructured pattern of care that reflects the complexity of managing severely ill patients during a public health crisis like the COVID-19 pandemic.

High levels of antimicrobial resistance (AMR) were found in healthy pigs in the Greater Accra region of Ghana in 2022; this led to awareness creation and education of pig farmers about how to improve antimicrobial practices and biosecurity. To assess changes in AMR after the intervention, we compared AMR, multi-drug resistance (MDR), and determined colistin resistance levels in healthy pigs in the region before (2022) and after (2024) the education of farmers. Rectal swabs (n = 140) from pigs in 14 farms were cultured for isolation of Enterobacterales (Escherichia coli and Enterobacter spp.) and subjected to antimicrobial susceptibility testing. A selective culture method was employed to isolate colistin-resistant Enterobacterales, which were further screened for the mcr-1 gene. AMR and MDR findings were compared with those from 140 pigs from the same farms in 2022. Enterobacterales were found in 137 (2022) and 138 (2024) rectal swabs, with Escherichia coli predominating. There was a marked increase in AMR prevalence for eight of the nine tested antibiotics in 2024. Notable increases in resistance were for tetracycline (58–82%), ampicillin (33–49%), and ciprofloxacin (3–33%). MDR prevalence was highest in Escherichia coli, increasing from 20% to 44%. Phenotypic colistin resistance was found in 44% of Escherichia coli isolates in 2024 (in 2022, using different methodology, phenotypic colistin resistance was 8%)—in 2024, the mcr-1 gene was found in 51% of these isolates. There were no relevant associations between farm and pig characteristics and prevalence of MDR and phenotypic colistin resistance. Although education is an important aspect of AMR control, the findings highlight that education alone cannot curb the rise of AMR. Further interventions including continuous surveillance, stronger regulatory policy on antimicrobial use, and behavioral interventions will be needed to mitigate the situation.

Increasing antimicrobial resistance (AMR) levels in Enterobacterales from pigs in Ghana prompted us to investigate farm feed, pig slurry, and farm water for Enterobacterales isolates, their antimicrobial resistance patterns, and antimicrobial residues. Between August and November 2024, we collected one sample each of feed, slurry, and water from 14 pig farms for microbiological analysis. Out of 42 samples, Enterobacterales (E. coli and Enterobacter spp.) were isolated from 30 (71.4%) samples, with the highest prevalence found in feed (85.7%), followed by slurry (78.6%) and water (50.0%). The prevalence of AMR to tetracyclines, trimethoprim-sulfamethoxazole, and ampicillin was high, with over 50% of isolates from slurry and water and 40% from feed exhibiting tetracycline resistance. Multi-drug resistance (MDR) was identified in nine (27.3%) isolates of Enterobacterales, with the highest prevalence found in feed (38.5%), then slurry (23.1%), and water (14.3%). Among 42 farm samples screened for colistin-resistant Enterobacterales, 10 (23.8%) exhibited phenotypic colistin resistance. No antimicrobial residues were detected. Risk factors associated with MDR included large farms with high pig turnover (p < 0.05) and the channelling of slurry into both covered and uncovered pits on the farm (p < 0.05). These high resistance levels underscore the urgent need for improved hygiene in feed, water, and slurry management, stricter antibiotic stewardship with veterinary oversight, and better enforcement of existing antibiotic use regulations on pig farms.

Background The coronavirus disease 2019 (COVID-19) has caused substantial morbidity and mortality on a global scale. A strong correlation has been found between COVID-19 treatment outcomes and noncommunicable diseases such as cancers. However, there is limited information on the outcomes of cancer patients who were hospitalised for COVID-19. Methods We conducted an analysis on data collected in a large prospective cohort study set-up by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). All patients with laboratory-confirmed or clinically-diagnosed SARS-CoV-2 infection were included. Cancer was defined as having a current solid organ or haematological malignancy. The following outcomes were assessed; 30-day in-hospital mortality, intensive care unit (ICU) admission, length of hospitalization and receipt of higher-level care. Results Of the 560,547 hospitalised individuals who were analysed, 27,243 (4.9%) had cancer. Overall, cancer patients were older and had more comorbidities than non-cancer patients. Patients with cancer had higher 30-day in-hospital mortality than non-cancer patients (29.1.3% vs 18.0%) and longer hospital stays (median of 12 days vs 8 days). However, patients with cancer were admitted less often to intensive care units than non-cancer patients (12.6% vs 17.1%) and received less invasive mechanical ventilation than non-cancer patients (4.5% vs 7.6%). The hazard ratio of dying from cancer, adjusted for age, sex and country income level was 1.18 (95%CI: 1.15-1.2). Conclusions This study's findings underscore the heightened vulnerability of hospitalized COVID-19 patients with cancer, revealing a higher mortality rate, longer hospital stays, and an unstructured pattern of care that reflects the complexity of managing severely ill patients during a public health crisis like the COVID-19 pandemic.

Objective Synthesise the published literature and national regulations on infrastructure, capabilities and capacities required to manage and quality assure clinical research. Introduction The World Health Assembly (WHA) resolution 75.8 (2022) called “for a strengthened global architecture for coordinated and high-quality clinical trials”. For this remit, infrastructure, capabilities, and capacities needed to design and deliver high-quality clinical trials must be understood and advanced. This rapid scoping review aims to identify the breadth of requirements and recommendations for effective management of clinical trials in regulations, national legislation and the published literature. The findings will be summarised into themes. It will inform a framework for the assessment and development of units undertaking observational studies and interventional clinical trials. Inclusion criteria Peer-reviewed literature, grey literature, and national legislation that recommends infrastructure, capabilities, and/or capacities needed to manage and quality assure clinical trials. Publications authored by those who design, manage, fund, sponsor, regulate or oversee clinical trials. Methods Peer-reviewed and grey literature will be identified through Medline, Embase, PsycINFO, and Global Health via Ovid; SCOPUS; the Web of Science Core Collection; and the WHO Global Index Medicus using specific field codes to increase the specificity of the search strings. No date, language, or geographic limits will be applied. Deduplicated titles and abstracts will be screened by two blinded reviewers with discrepancies resolved by a third reviewer. Grey literature may be identified through the peer reviewed literature, supplemented with structured searches of Google and DynaMed. National regulations will be sourced online and from available summaries. Full text literature and regulations will be screened by a single reviewer, with proportionate verification by a second reviewer. Data will be extracted and coded for patterns in NVivo software. All items and codes will be summarised using a thematic framework analysis and identify core constructs within each theme.

Objective Synthesise the published literature and national regulations on infrastructure, capabilities and capacities required to manage and quality assure clinical research. Introduction The World Health Assembly (WHA) resolution 75.8 (2022) called “for a strengthened global architecture for coordinated and high-quality clinical trials”. For this remit, infrastructure, capabilities, and capacities needed to design and deliver high-quality clinical trials must be understood and advanced. This rapid scoping review aims to identify the breadth of requirements and recommendations for effective management of clinical trials in regulations, national legislation and the published literature. The findings will be summarised into themes. It will inform a framework for the assessment and development of units undertaking observational studies and interventional clinical trials. Inclusion criteria Peer-reviewed literature, grey literature, and national legislation that recommends infrastructure, capabilities, and/or capacities needed to manage and quality assure clinical trials. Publications authored by those who design, manage, fund, sponsor, regulate or oversee clinical trials. Methods Peer-reviewed and grey literature will be identified through Medline, Embase, PsycINFO, and Global Health via Ovid; SCOPUS; the Web of Science Core Collection; and the WHO Global Index Medicus using specific field codes to increase the specificity of the search strings. No date, language, or geographic limits will be applied. Deduplicated titles and abstracts will be screened by two blinded reviewers with discrepancies resolved by a third reviewer. Grey literature may be identified through the peer reviewed literature, supplemented with structured searches of Google and DynaMed. National regulations will be sourced online and from available summaries. Full text literature and regulations will be screened by a single reviewer, with proportionate verification by a second reviewer. Data will be extracted and coded for patterns in NVivo software. All items and codes will be summarised using a thematic framework analysis and identify core constructs within each theme.

The agreement at the time the human genome was first sequenced to release the data to the public domain set an example that encouraged other scientists doing other types of research to share their data freely to empower scientific discovery and minimize the burden of disease. There are still many barriers to data sharing, including how to ensure patient privacy, manage intellectual property, and reduce inequity in data reuse, with a one-way flow of raw data from less developed countries to wealthy countries and corporations that produce medical countermeasures that may first go to the highest bidder. In an era of increasing infectious disease outbreaks, ensuring the efficient exchange of research data is essential to expeditious response to emerging pathogens, especially in the urgent case of a potential or actual pandemic. This chapter will review principles of open access to research highlighted by the coronavirus disease 2019 (COVID-19) pandemic and current challenges to establishment of a global data-sharing system meeting the needs and interests of all the stakeholders, that is, every living human being.