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To describe activities and outcomes of a cross-team capacity building strategy that took place over a five-year funding period within the broader context of 12 community-based primary health care (CBPHC) teams.
In 2013, the Canadian Institutes of Health Research funded 12 CBPHC Teams (12-Teams) to conduct innovative cross-jurisdictional research to improve the delivery of high-quality CBPHC to Canadians. This signature initiative also aimed to enhance CBPHC research capacity among an interdisciplinary group of trainees, facilitated by a collaboration between a capacity building committee led by senior researchers and a trainee-led working group.
After the committee and working group were established, capacity building activities were organized based on needs and interests identified by trainees of the CBPHC Teams. This paper presents a summary of the activities accomplished, as well as the outcomes reported through an online semistructured survey completed by the trainees toward the end of the five-year funding period. This survey was designed to capture the capacity building and mentorship activities that trainees either had experienced or would like to experience in the future. Descriptive and thematic analyses were conducted based on survey responses, and these findings were compared with the existing core competencies in the literature.
Since 2013, nine webinars and three online workshops were hosted by trainees and senior researchers, respectively. Many of the CBPHC Teams provided exposure for trainees to innovative methods, CBPHC content, and showcased trainee research. A total of 27 trainees from 10 of the 12-Teams responded to the survey (41.5%). Trainees identified key areas of benefit from their involvement in this initiative: skills training, networking opportunities, and academic productivity. Trainees identified gaps in research and professional skill development, indicating areas for further improvement in capacity building programs, particularly for trainees to play a more active role in their education and preparation.
The aim of this work was to study the acceptability of plans prepared for prostate patients treated by volumetric modulated arc therapy (VMAT) with the vision to evaluate the quality of plans and test pre-treatment quality assurance (QA).
VMAT plans of 35 patients, planned on the Eclipse Treatment Planning System (Aria 15), were included in the study. Plan acceptability was checked using statistical analysis, which includes homogeneity index, radical and median homogeneity index, coverage and uniformity index. Dose–volume histograms (DVH) of the plans were also studied to check prescribed dose (PD), Dmax, Dmin, D5 and D95. Portal dosimetry was also done by gamma analysis using 3%/3 mm criterion. SD and mean SD error were also calculated and analysed.
Statistical analysis showed a mean HI of 1·054, coverage 0·959, UI 1·055, mDHI 0·962 and rDHI 0·866. SD of HI, coverage, UI, mDHI and rDHI was 0·019, 0·019, 0·014, 0·013 and 0·030, respectively. From the DVHs, mean of D5, D95, Dmin and Dmax was calculated at 6,252·9, 5,757·4, 6,413·3 and 5,657·7 cGy, respectively, with a prescribed dose of 6,000 cGy. According to gamma analysis, area gamma < 1 was 99·12% with a tolerance limit of 95%, maximum gamma was 1·466 with a tolerance limit of 3·5, average gamma was 0·388 with a tolerance limit of 0·5, area gamma > 1·2 was 0·242% with a tolerance limit of 0·5%, maximum dose difference was 0·6 with a tolerance limit of 1·0 and average dose difference was 0·029 with a tolerance limit of 0·2.
All three computations showed the results to be within acceptable limits. VMAT possesses a unique feature of delivering the whole treatment with only two rotations of the gantry. VMAT has an improved efficiency of delivery for equivalent dosimetric quality.
Critical literature on the history of developmentalism in the Global South has so far laid emphasis on the authorising force generated by the future telos of attaining the status of a ‘developed country’, by various developmental institutions and their violently transformative programmes for well over the previous century. Much like other significant utopias of the twentieth century, this promised telos was very rarely (if ever) actualised – its persistent quest has, instead, generated several monumental calamities. But, this is where the similarities between developmental futures and ‘mass Utopias’ come to an end. For while these other dreamworlds have, under the burden of their catastrophes, become ‘futures past’ in a ‘post–Cold War’ world, developmentalism has only tightened its grip, seemingly impervious to the vast catalogue of failures of its promises in this ‘age of catastrophe’.
This paper deals with the problem of the formation control of nonholonomic mobile robots in the leader–follower scenario without considering the leader information, as a result of its velocity and position. The kinematic model is reformulated as a formation model by incorporating the model uncertainties and external disturbance. The controller is presented in the two-step process. Firstly, the tracking problem is taken into consideration, which can be used as a platform to design a controller for the multi-agents. The proposed controller is designed based on a non-singular fast terminal sliding mode controller (FTSMC), which drives the tracking error to zero in finite time. It not only ensures the tracking but also handles the problem related to non-singularities. Moreover, the design control scheme is modified using high-gain observer to resolve the undefined fluctuations due to man-made errors in sensors. Secondly, the multi-agent tracking problem is considered; hence, a novel formation control is designed using FTSMC, which ensures the formation pattern as well as tracking. Furthermore, the obstacle avoidance algorithm is incorporated to avoid the collision, inside the region of interest. With the Lyapunov analysis, the stability of the proposed algorithm is verified. As a result, simulated graphs are shown to prove the efficacy of the proposed control scheme.
Shock–shock interaction structures and a newly discovered dynamic instability in granular streams resulting from such interactions are presented. Shock waves are generated by placing two similar triangular wedges in a gravity-driven granular stream. When the shock waves interact, grains collapse near the centre region of the wedges and a slow-moving concentrated diamond-shaped streak of grains is formed that grows as the inclination of the channel is increased. The diamond streak, under certain geometric conditions, is found to become unstable and start oscillating in the direction transverse to the mainstream. When the wedges are placed too close to each other, the granular flux of the incoming stream is unable to pass through the small gap, resulting in the formation of a single bow shock enveloping both the wedges. Experiments are performed for a wide range of flow speeds, wedge angles and wedge separations to investigate the interaction zone. We discuss a possible mechanism for the formation of the central streak and the associated dynamic instability observed for specific physical parameters.
While the burden of dementia is increasing in low- and middle-income countries, there is a low rate of diagnosis and paucity of research in these regions. A major challenge to study dementia is the limited availability of standardised diagnostic tools for use in populations with linguistic and educational diversity. The objectives of the study were to develop a standardised and comprehensive neurocognitive test battery to diagnose dementia and mild cognitive impairment (MCI) due to varied etiologies, across different languages and educational levels in India, to facilitate research efforts in diverse settings.
A multidisciplinary expert group formed by Indian Council of Medical Research (ICMR) collaborated towards adapting and validating a neurocognitive test battery, that is, the ICMR Neurocognitive Tool Box (ICMR-NCTB) in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam), for illiterates and literates, to standardise diagnosis of dementia and MCI in India.
Following a review of existing international and national efforts at standardising dementia diagnosis, the ICMR-NCTB was developed and adapted to the Indian setting of sociolinguistic diversity. The battery consisted of tests of cognition, behaviour, and functional activities. A uniform protocol for diagnosis of normal cognition, MCI, and dementia due to neurodegenerative diseases and stroke was followed in six centres. A systematic plan for validating the ICMR-NCTB and establishing cut-off values in a diverse multicentric cohort was developed.
A key outcome was the development of a comprehensive diagnostic tool for diagnosis of dementia and MCI due to varied etiologies, in the diverse socio-demographic setting of India.
Alveolar echinococcosis (AE) is a zoonotic parasitic diseases caused by a cestode parasite known as Echinococcus multilocularis. The parasite has a wildlife cycle with definitive hosts (foxes) and small mammals as intermediate hosts (rodents) while humans are the accidental hosts. Parasite infection pressure relation to time of the year and age dependent infection pressure for parasite abundance also depend on the urbanization. The aim of current work is forecasting the thresholds via the computational analysis of the disease spread which is a useful approach since it can help to design the experimental settings with better planning and efficiency. Network analysis when interlinked with the computational techniques provides better insight into the spatial and temporal heterogeneities. In the present study, a mathematical framework that describes the transmission dynamics and control measures of E. multilocularis in foxes is documented. We used treatment of foxes with baits for the prevention of the E. multilocularis infection. A novel approach of networking, called Petri net (PN), based on density dependent differential equations, is utilized during this research. The accurate description of the transmission of the parasite and the effect of drug on it is provided to the readers in this article. The transitions, which are difficult to analyse theoretically, are presented with the aid of the discrete approach of networking. A discrete mathematical framework can prove to be an accurate and robust tool to analyse and control the parasite dynamics.
Seizures and epilepsy are frequently misdiagnosed. Only about 50% of patients transferred to ICUs in tertiary hospitals after presumed status epilepticus are found to have status epilepticus.1 About 90% of those misdiagnosed with epilepsy actually have psychogenic nonepileptic event (PNEE).2 There are many other disorders misdiagnosed as epilepsy, organic and nonorganic, seen in adults and children. This chapter discusses the common differential diagnoses for epilepsy in hopes of making recognition of epilepsy imitators easier. As with any disorder, misdiagnosis delays the appropriate treatment needed to provide relief to the patient. In PNEE, a completely different therapeutic approach is needed (versus epileptic seizures), including psychotherapy and psychotropic medications. Antiseizure drugs (ASDs) used in those who do not need them place an unnecessary risk of common and rare side effects.
Drought stress negatively affects the cotton production all over the world. The negative impact of drought varies for different species due to some morphological and root attributes that help some species to better stand under drought. But the extent of disturbance varies for different cotton species. To find out such variation, two cotton species (Gossypium hirsutum and Gossypium arboreum) were studied under normal and drought conditions for 2 years. Two genotypes for each species were included, i.e. PC-1 and COMILLA (G. arboreum) and IUB-13 and IUB-65 (G. hirsutum). The experiment was laid out under a completely randomized design following factorial arrangement. Genotype × treatment × year interaction of cotton genotypes was studied for different root, morphological, physiological and fibre-related traits. Traits such as above ground dry biomass, above ground fresh biomass, chlorophyll contents, leaf area, seed cotton yield, sympodial branches/plant, fibre strength and ginning out-turn were higher in G. hirsutum genotypes as compared to G. arboreum genotypes. However less reduction under drought in all above mentioned traits was recorded for G. arboreum, than G. hirsutum. Furthermore, root traits; primary root length, lateral root numbers, root fresh weight and root dry weight were enriched under drought condition in G. arboreum genotypes than in G. hirsutum genotypes, which is a clear manifestation of higher drought tolerance ability in G. arboreum genotypes transferrable to G. hirsutum genotypes through interspecific crossing or other means.
In contrast to the literature on the applicability of civil and political rights in armed conflict and other situations of violence, internationally recognised economic, social and cultural rights have been largely ignored. The legal guarantees related to work, food, housing, healthcare, social security or education are not generally seen as a priority amid widespread armed violence, since other affected rights relating to life, liberty and security typically attract greater attention. Accordingly, protection of education has never been considered as a priority during and after armed conflict.
This study explores the experiences and practices of emergency medical services (EMS) providers, as well as the motivations that underpin perceptions toward standard infection prevention and control (IPC). The current literature suggests that EMS providers have a low compliance level with preventive measures, with misperceptions about risks and self-justification of personal skills reported.
The study used qualitative methods and conducted 2 distinct focus group discussions and 20 in-depth interviews with both prehospital and inter-facility EMS providers. Data were thematically analyzed using the Framework approach.
The participants considered respiratory infections the most significant nosocomial risks. Lack of full disclosure of medical history to EMS providers was considered a significant threat. Beliefs about low effectiveness and harmful effects of the influenza vaccine, as well as low perceptions of influenza risks, were common. While apparent misperceptions contributed largely to the inappropriate use of preventive measures, the reliance on intuition and individual experiences was attributed to the inaccessibility of appropriate guidelines, and lack of formal IPC training programs.
There is need to address EMS doubts and fears, improve IPC practices and awareness by institutionalizing IPC training programs, and ensure the design and accessibility of simplified and well-tailored IPC guidelines for EMS providers.
Improving the production traits and resistance against mastitis in dairy cattle is a challenge for animal scientists across the globe. The present study was designed to investigate the genetic effects of single nucleotide polymorphisms (SNPs) in Janus kinase 2 (JAK2) and diacylglycerol acyltransferase (DGAT1) genes with production and mastitis-related traits. Four SNPs in JAK2 and one in DGAT1 were analyzed through Chinese Cow's SNPs Chip-I (CCSC-I) and genotyped in a population of 312 Chinese Holsteins. Our findings demonstrated that milk fat percentage, somatic cell count (SCC), somatic cell score (SCS), serum cytokines interleukin 6 (IL-6) and interferon gamma (IFN-γ) showed significant associations (P < 0.05) with at least one or more identified SNPs. Consequently, the analysis based on haplotypes amongst the SNPs in JAK2 revealed noteworthy (P < 0.05) association with SCC and IL-6. Collectively, our results verified the pleiotropic ability of detected SNPs in bovine JAK2 and DGAT1 for milk fat percentage as well as mastitis-related traits. The significant SNPs in both the genes could serve as powerful genetic markers to minimize mastitis risk. In addition, besides SCC and SCS, the IFN-γ and IL-6 could also be used as indicators of improved genetic resistance against mastitis.
We sought to establish the impact on vaccine uptake of sending out a single appointment letter inviting patients to attend a vaccine clinic.
Coeliac disease is associated with splenic dysfunction and so patients with coeliac disease are at a higher risk of overwhelming infection. Additional vaccinations are recommended for these individuals to provide additional protection against infection.
We retrospectively identified 54 patients with diagnosed coeliac disease, and all vaccines previously received by these patients. By comparing this to the Green Book [Department of Health (2013) Immunisation of individuals with underlying medical conditions: the green book, chapter 7, London: Department of Health. Retrieved 26 February 2019 from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/566853/Green_Book_Chapter7.pdf], we determined the patients who were due vaccinations and the specific vaccines they were due. An invitation letter was then sent out to patients requiring further vaccinations and vaccine uptake for these patients was re-audited six months later.
Our results show a mild increase in the total uptake of vaccines six months after the letter was sent out, from 38.6% to 49.2%.
Evidence suggests that sub-optimal maternal nutrition has implications for the developing offspring. We have previously shown that exposure to a low-protein diet during gestation was associated with upregulation of genes associated with cholesterol transport and packaging within the placenta. This study aimed to elucidate the effect of altering maternal dietary linoleic acid (LA; omega-6) to alpha-linolenic acid (ALA; omega-6) ratios as well as total fat content on placental expression of genes associated with cholesterol transport. The potential for maternal body mass index (BMI) to be associated with expression of these genes in human placental samples was also evaluated. Placentas were collected from 24 Wistar rats at 20-day gestation (term = 21–22-day gestation) that had been fed one of four diets containing varying fatty acid compositions during pregnancy, and from 62 women at the time of delivery. Expression of 14 placental genes associated with cholesterol packaging and transfer was assessed in rodent and human samples by quantitative real time polymerase chain reaction. In rats, placental mRNA expression of ApoA2, ApoC2, Cubn, Fgg, Mttp and Ttr was significantly elevated (3–30 fold) in animals fed a high LA (36% fat) diet, suggesting increased cholesterol transport across the placenta in this group. In women, maternal BMI was associated with fewer inconsistent alterations in gene expression. In summary, sub-optimal maternal nutrition is associated with alterations in the expression of genes associated with cholesterol transport in a rat model. This may contribute to altered fetal development and potentially programme disease risk in later life. Further investigation of human placenta in response to specific dietary interventions is required.
We investigated whether changes in nutrient availability affected N, P, S and polyphenol concentrations in different leaf-development stages of three brevideciduous and three evergreen dominant woody species in a nutrient-limited savanna woodland in Central Brazil. Treatments included eight years of annual fertilization with 100 kg ha−1 of N, P, N plus P and control, each replicated in four randomized 15 × 15-m plots. All species increased S concentrations (minimum 28%) in young and mature leaves in fertilized plots. Dalbergia miscolobium decreased total phenol concentrations with P (−34.3%, −23.7%) and NP fertilization (−28.2%, −17.1%). Blepharocalyx salicifolius increased total phenol (27.6%, 18.8%) and tannin (46.3%; 43.5%) in P fertilized and increased total phenol (33.9%) and tannin (27.8%, 43.5%) in NP fertilized plots. Total phenol concentration decreased with leaf age in Ouratea hexasperma, Styrax ferrugineus and Blepharocalyx salicifolius, which also decreased tannin concentration with leaf age. For all treatments, brevideciduous species had higher N, P, total phenols and tannin concentrations and lower S concentration than evergreens. These differences between phenological groups suggest that tropical ecosystems responses to environmental changes are more complex than anticipated by global vegetation models, with consequences for predictions in ecosystem functions and resilience.