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Innovation platforms are fast becoming part of the mantra of agricultural research for development projects and programmes. Their basic tenet is that stakeholders depend on one another to achieve agricultural development outcomes, and hence need a space where they can learn, negotiate and coordinate to overcome challenges and capture opportunities through a facilitated innovation process. Although much has been written on how to implement and facilitate innovation platforms efficiently, few studies support ex-ante appraisal of when and for what purpose innovation platforms provide an appropriate mechanism for achieving development outcomes, and what kinds of human and financial resource investments and enabling environments are required. Without these insights, innovation platforms run the risk of being promoted as a panacea for all problems in the agricultural sector. This study makes clear that not all constraints will require innovation platforms and, if there is a simpler and cheaper alternative, that should be considered first. Based on the review of critical design principles and plausible outcomes of innovation platforms, this study provides a decision support tool for research, development and funding agencies that can enhance more critical thinking about the purposes and conditions under which innovation platforms can contribute to achieving agricultural development outcomes.
In the highlands of northwestern Ethiopia, Orthodox Christian churches provide habitats for plants that have become rare in the surrounding agricultural landscapes. The objective of this paper is to investigate why and how the local clergy and laypeople protect and promote woody plants within their sacred spaces. Interviews at 11 churches in the Debark District of North Gonder generated a list of 47 woody species, of which most are rare in the rest of the landscape. Three tree species (indigenous cedar, Juniperus procera; indigenous olive, Olea europaea subsp. cuspidata; and exotic Eucalyptus globulus) were identified as most important. While cedar and olive are symbols of tradition and witnesses to church history, eucalyptus is a source of income and alternative material for church construction and repair. A significant proportion of indigenous species within Debark's church forests were said to have been planted, including cedars and olives. Knowledge that these species are cultivated enhances the conservation value of these forests by inspiring local people to continue planting trees and shrubs. In addition to serving as refugia for rare species, Ethiopia's church forests nurture the knowledge necessary to promote plant diversity in the rest of the landscape and serve as archetypes for community-driven conservation.
Observational studies and treatment trials investigating nutrition and cognitive function, with a focus on folate and soya and dementia, were reviewed. Data suggested that effects of folic acid based interventions may only be shown before cognitive decline is evident and/or if people are folate deficient. In older people in Indonesia, Hawai'i and China, tofu, which can contain high levels of phytoestrogens, was found to increase dementia risk. This association was not mediated by a vegetarian diet, socioeconomic status, formaldehyde, thyroid function, or loss of teeth. On the other hand, human observational and animal treatment studies suggested that tempe, a fermented soya product containing phytoestrogens and folate, reduced dementia risk and improved memory. High oestrogen levels were found to increase dementia risk in older women. However, in women with adequate serum folate, high oestrogen levels did not confer additional dementia risk and may protect ageing neurons. In conclusion, reviews seem to suggest that folic acid interventions are only effective on cognitive outcomes in people who are folate deficient and do not have cognitive impairment. Frequent consumption of tofu may have detrimental effects on memory and increase dementia risk in older East Asian people, while tempe may reduce these risks. Possibly folate in tempe offsets the potential negative effects of oestrogenic compounds on ageing neurons.
To understand physician preferences and bleeding complication rates of intramuscular botulinum neurotoxin type A injections for spasticity management in anticoagulated patients, questionnaires were mailed to 138 physicians across Canada. The international normalized ratio comfort range for injections was <2.0 in 10%, 2.0 to 2.5 in 35%, 2.6 to 3.0 in 25%, and 3.1 to 3.5 in 20% of physicians. Only 23% injected outside their comfort value and 57% did not; 72% did not normalize the international normalized ratio value before injections. Only one injector reported the development of compartment syndrome. As expected, high variability exists in physician preferences in botulinum neurotoxin type A injection in anticoagulated patients.
There is a question of whether a single assessment tool can assess the key competencies of residents as mandated by the Royal College of Physicians and Surgeons of Canada CanMEDS roles framework.
The objective of the present study was to investigate the reliability and validity of an emergency medicine (EM) in-training evaluation report (ITER).
ITER data from 2009 to 2011 were combined for residents across the 5 years of the EM residency training program. An exploratory factor analysis with varimax rotation was used to explore the construct validity of the ITER. A total of 172 ITERs were completed on residents across their first to fifth year of training.
A combined, 24-item ITER yielded a five-factor solution measuring the CanMEDs role Medical Expert/ Scholar, Communicator/Collaborator, Professional, Health Advocate and Manager subscales. The factor solution accounted for 79% of the variance, and reliability coefficients (Cronbach alpha) ranged from α = 0.90 to 0.95 for each subscale and α = 0.97 overall. The combined, 24-item ITER used to assess residents’ competencies in the EM residency program showed strong reliability and evidence of construct validity for assessment of the CanMEDS roles.
Further research is needed to develop and test ITER items that will differentiate each CanMEDS role exclusively.
Immunodeficient patients are at higher risk for developing lymphoproliferative disorders (LPDs), above all non-Hodgkin lymphomas (NHLs). Even though the association between primary immunodeiciency diseases (i.e. X-linked lymphoproliferative syndrome, common variable immunodeiciency, ataxia telangiectasia, and Wiskott-Aldrich syndrome) and LPDs, on the one hand, and between LPDs and autoimmune diseases, on the other, is well known, the leading causes of immunosuppression are, at present, organ transplantation and human immunodeiciency virus (HIV) infection. Lymphomas in the immunocompromised host have been traditionally regarded as having a more aggressive course, including extranodal involvement, a more rapid clinical course, poorer response to conventional therapies, and poorer outcome, but this has been called into question both in post-transplant lymphoproliferative disorders (PTLD) following solid organ transplant (SOT) and HIV-related lymphoma by more recent publications.
Tumors following solid organ transplantation (PTLD)
PTLDs are well recognized and potentially life-threatening complications after SOT. PTLD is seen in up to 10% of all SOT recipients. It is the most common form of post-transplant malignancy in children and in adults it is the second most common malignancy after skin cancer. In both children and adults it is the most common cause of cancer-related mortality after SOT, with the reported overall mortality for PTLD exceeding 50%. Up to 85% of PTLDs are of B-cell lineage and most of these (over 80%) are associated with Epstein-Barr virus (EBV) infection. Around 10-15% of PTLDs are of T-cell lineage, around 30% of which are associated with EBV.
Ten centuries ago, the celebrated Persian poet Nasir Khusraw lamented the Islam he saw around him as one characterized by literalism and legalism, even as he made a case for enlightening the understanding of one's faith through investigation, analysis and informed praxis. As we reflect on the terrible tragedy of 9/11, those of us who are Muslims, and those of us who study Islam in the Academy may be struck by the double bind in which we find ourselves.
On the one hand, engaging the question, “Why would they hate us so much so as to instigate such a senseless, tragic act?” raises doubts about our patriotic spirit at the same time as it illuminates the consequences of our, and might I add, European foreign policy during the last 150 years.
On the other hand, even as we rise to defend Islam and Muslims against mandating and undertaking such a heinous assault on innocent human lives through a hermeneutic that distances the perpetrators from Ordinary Muslims and affirms the close affinity Islam has with Judaism and Christianity, we are forced to admit that, yes, the pilots and their accomplices were card-carrying Muslims, yes, they looked to their own understanding of Islam to fortify their spirits prior to their acts, and yes, a legalistic and literalistic interpretation of Islam has come to the forefront of public discourse in recent decades and evidence of this is to be found globally wherever there are conflicts involving Muslims.
To investigate recognition of diagnostic overshadowing, i.e., misattribution of physical symptoms to mental illness, among emergency medicine professionals; further, to identify contributory and mitigating factors to diagnostic overshadowing.
In-depth individual interviews of 25 emergency department clinicians and qualitative analysis using thematic analysis.
Diagnostic overshadowing was described as a significant issue. Contributing factors included: (1) problems of knowledge and information gathering; (2) clinicians' attitudes toward people with mental illness, substance misuse and frequent attenders; and (3) difficulties in working with mental health services in the context of a 4-h target for discharge from the emergency department. Avoidance of patients with a psychiatric diagnosis was also described, due to fear of violence.
The physical health care of people with mental illness in emergency departments may be adversely affected by diagnostic overshadowing and avoidance by clinical staff, along with difficulties created by the illness, medication and the emergency department environment. Greater joint working between psychiatric and emergency department staff is suggested as one way to reduce diagnostic overshadowing.
Direct social contact interventions are known to reduce mental health stigma. Filmed social contact may be equally effective and have practical and cost advantages.
To compare the effectiveness of a DVD, a live intervention and a lecture control, in reducing stigma, testing the hypotheses that: (a) DVD and live interventions will be equally effective; and (b) the interventions with social contact (DVD/live) will be more effective than the lecture. Cost-effectiveness, process and acceptability are also assessed.
Student nurses were randomised to: (a) watch a DVD of service users/informal carers talking about their experiences, (b) watch a similar live presentation, or (c) attend a lecture. Primary outcomes were changes in attitudes (using the Mental Illness: Clinicians Attitudes Scale, MICA), emotional reactions (using the Emotional Reactions to Mental Illness Scale, ERMIS), intended proximity (using the Reported and Intended Behaviour Scale, RIBS), and knowledge (using the Social Contact Intended Learning Outcomes, SCILO), immediately after the intervention and at 4-month follow-up.
For the 216 participants, there were no differences between the DVD and live groups on MICA, ERMIS or RIBS scores. The DVD group had higher SCILO (knowledge) scores. The combined social contact group (DVD/live) had better MICA and RIBS scores than the lecture group, the latter difference maintained at 4 months. The DVD was the most cost-effective of the interventions, and the live session the most popular.
Our hypotheses were confirmed. This study supports the wider use of filmed social contact interventions to reduce stigma about mental illness.
If we consider the “life cycle” of a domesticated species, we might divide it into six phases: (1) wild harvesting and (potentially) disruptive selection; (2) incipient cultivation and adaptation to agro-habitats; (3) domestication through cultural selection of a limited gene pool in agro-habitats; (4) diffusion and adaptation to other agro-habitats, with potential introgression with wild or domesticated relatives; (5) diversification and further selection through intentional breeding or fortuitous introgression; and (6) local extirpation and in some cases, global extinction. Although science historians primarily regard Nikolai Vavilov and Jack Harlan in terms of their contributions to our understanding of crop domestication and diffusion (Nabhan 2009), they were actually intellectually and practically engaged to some extent in observing and reporting on all six of the phases noted above.
Since the deaths of Vavilov and Harlan, there has been tremendous progress made in our scientific understanding of the first five phases in these crop life cycles, thanks to innovative collaborations among geneticists, archaeologists, biogeographers, ethnobiologists, and agricultural historians. However, one might argue that our scientific understanding of crop extirpation and extinction processes has lagged far behind that which conservation biologists have gained for wild species. While the body of scholarly literature on agricultural origins and dispersals has grown exponentially since the pioneering work of Vavilov, Sauer, Harlan, deWet, Zhukovsky, Zohary, and Darlington, we have largely seen anecdotal evidence and emotive interpretations regarding the causes, cultural processes, and consequences of genetic erosion, local crop extirpations, and global extinctions. There are exceptions, of course, such as the fine work of Stephen Brush, his colleagues, and students, but these notable exceptions prove the rule.