Impact perforation testing of stab-resistant armour materials

This paper describes the development of a method for the investigation and comparison of materials for use in stab resistant body armour. A number of polymer composite panels of different thicknesses and construction have been tested. A dynamic test which simulated the real threat has been used and the results compared to a simpler quasi-static test that might be used in initial materials selection. The materials tested were glass-epoxy, and glass-nylon composite panels of several thicknesses between 1.8 and 5.8mm. Additional tests were also performed on similar composites containing tungsten wires. An accelerated instrumented drop-tower was used to drive a knife through composite panels and record the force resisting penetration by the knife. The final penetration of the knife through the armour into a soft backing was also measured. For comparison,a similar geometry quasi-static test was carried out on the same specimens. It was found that energy absorbtion took the form of an initial resistance to perforation and then by a resistance to further penetration. This is thought to stem from resistance to cutting ofthe panel material and gripping of the knife blade. The energy required to produce a given penetration in dynamic tests was found to be in good agreement with the penetration achieved at similar energies under quasi-static conditions. For the materials tested there was no significant difference between the penetration resistance of single or two layer systems. The penetration achieved through a panel of a given material was approximately proportional to the inverse square of the panel's thickness. The relative performance of different armour materials was assessed by plotting the energy required to penetrate a fixed distance against the areal density of the panel

The Assessment of Safe Nursing Care: development and psychometric evaluation

This paper discusses the development of an instrument to assess safe nursing care snd the process of evaluating its reliability and valdit

Treatment of child wasting: Child Health Research Initiative (CHNRI) prioritisation exercise dataset

Child wasting (low weight for height) affects approximately 49.5 million children under five years globally. The aim of the Child Health Research Initiative (CHNRI) prioritisation exercise, performed on behalf of 'No Wasted Lives', was to identify and prioritise key outstanding research questions that would enable child wasting to be treated more effectively and at greater scale. This quantitative dataset contains responses of 313 participants to a survey questionnaire performed on approaches to acute malnutrition treatment. Data available on request (with appropriate data sharing agreement) from No Wasted Lives, Action Against Hunger authors named as contacts

Prevention of child wasting: Results of a Child Health & Nutrition Research Initiative (CHNRI) prioritisation exercise.

BACKGROUND: An estimated 49.5 million children under five years of age are wasted. There is a lack of robust studies on effective interventions to prevent wasting. The aim of this study was to identify and prioritise the main outstanding research questions in relation to wasting prevention to inform future research agendas. METHOD: A research prioritisation exercise was conducted following the Child Health and Nutrition Research Initiative method. Identified research gaps were compiled from multiple sources, categorised into themes and streamlined into forty research questions by an expert group. A survey was then widely circulated to assess research questions according to four criteria. An overall research priority score was calculated to rank questions. FINDINGS: The prioritised questions have a strong focus on interventions. The importance of the early stages of life in determining later experiences of wasting was highlighted. Other important themes included the identification of at-risk infants and young children early in the progression of wasting and the roles of existing interventions and the health system in prevention. DISCUSSION: These results indicate consensus to support more research on the pathways to wasting encompassing the in-utero environment, on the early period of infancy and on the process of wasting and its early identification. They also reinforce how little is known about impactful interventions for the prevention of wasting. CONCLUSION: This exercise provides a five-year investment case for research that could most effectively improve on-the-ground programmes to prevent child wasting and inform supportive policy change

Children living with disabilities are neglected in severe malnutrition protocols: a guideline review.

PURPOSE: Children living with disabilities are at high risk of malnutrition but have long been marginalised in malnutrition treatment programmes and research. The 2013 WHO guidelines for severe acute malnutrition (SAM) mention disability but do not contain specific details for treatment or support. This study assesses inclusion of children living with disabilities in national and international SAM guidelines. METHODS: National and international SAM guidelines available in English, French, Spanish or Portuguese were sourced online and via direct enquiries. Regional guidelines or protocols subspecialising in a certain patient group (eg, people living with HIV) were excluded. Eight scoping key informant interviews were conducted with experts involved in guideline development to help understand possible barriers to formalising malnutrition guidance for children living with disabilities. RESULTS: 71 malnutrition guidelines were reviewed (63 national, 8 international). National guidelines obtained covered the greater part of countries with a high burden of malnutrition. 85% of guidelines (60/71) mention disability, although mostly briefly. Only 4% (3/71) had a specific section for children living with disabilities, while the remaining lacked guidance on consistently including them in programmes or practice. Only one guideline mentioned strategies to include children living with disabilities during a nutritional emergency. Most (99%,70/71) did not link to other disability-specific guidelines. Of the guidelines that included children living with disabilities, most only discussed disability in general terms despite the fact that different interventions are often needed for children with different conditions. Interviews pointed towards barriers related to medical complexity, resource constraints, epidemiology (eg, unrecognised burden), lack of evidence and difficulty of integration into existing guidelines. CONCLUSION: Children living with disabilities are under-recognised in most SAM guidelines. Where they are recognised, recommendations are very limited. Better evidence is urgently needed to identify and manage children living with disabilities in malnutrition programmes. More inclusion in the 2022 update of the WHO malnutrition guidelines could support this vulnerable group

Research priorities to improve the management of acute malnutrition in infants aged less than six months (MAMI)

Worldwide, 8.5 million infants aged less than 6 months (<6m) are acutely malnourished. For the first time, 2013 WHO Malnutrition Guidelines describe their treatment, but on the basis of “very low quality” evidence, per WHO. More and better research is urgently needed. To prioritise the many possible research questions on infant <6m malnutrition, we used the systematic, transparent, well-established Child Health and Nutrition Research Initiative (CHNRI) approach. Sixty-four experts scored 60 research questions on the basis of their answerability, likelihood of intervention efficacy, effectiveness, deliverability, sustainability, impact on disease burden, and impact on equity. “How should infant <6m SAM be defined?” was the top-scoring research question; that this and other basic questions are still needed highlights paucity of evidence on this topic. Other leading questions reflect interest in public health/community-focused models of care, e.g., “What are priority components of a package of outpatient care?” These questions are important to inform new outpatient strategies now recommended by WHO. Most of our questions received high-priority scores reflecting a great need for a wide variety of evidence. Several major global initiatives such as the “Scaling Up Nutrition Movement” and “Generation Nutrition” would benefit from better evidence. Our results show clear ways forward for future research investments

Treatment of child wasting: results of a child health and nutrition research initiative (CHNRI) prioritisation exercise

Background: Child wasting is highly prevalent, with around 49.5 million children under five years affected globally. More evidence is needed to inform the scale up of effective treatment of wasted children worldwide. The aim of this study was to identify and prioritise the main outstanding research questions relating to the treatment of wasting to inform future research agendas. Methods: A research prioritisation exercise was undertaken using the Child Health and Nutrition Research Initiative method. Research gaps were identified from multiple sources, grouped in themes and condensed into a list of 53 research areas by a group of experts. An online survey was developed and circulated globally to individuals working in the global nutrition sector. Participants evaluated each research area according to four agreed criteria. Research areas were then ranked according to an overall research priority score. Results: A total of 394 individuals from 63 countries participated in the survey. Research areas prioritised by the group focused on the effective detection and diagnosis of ‘high risk’ wasted children in the community; provision of a continuum of care; and early life course interventions. The group also prioritised evidence to inform guidance on the impatient management of wasted children with diarrhoea; prevention of post-treatment relapse and mortality; and the optimisation of ready-to-use therapeutic foods in treatment programmes. Conclusions: Critical gaps in our understanding of the treatment of wasting must be filled to inform guidance, policy and programming to ensure that all wasted children receive the treatment services that they need. A coordinated research agenda across treatment and prevention is urgently needed to maximise the impact of funding investments towards the meeting of global targets to reduce child wasting