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The objectives of this paper are to: (1) identify contextual factors such as policy that impacted the implementation of community-based primary health care (CBPHC) innovations among 12 Canadian research teams and (2) describe strategies used by the teams to address contextual factors influencing implementation of CBPHC innovations. In primary care settings, consideration of contextual factors when implementing change has been recognized as critically important to success. However, contextual factors are rarely recorded, analyzed or considered when implementing change. The lack of consideration of contextual factors has negative implications not only for successfully implementing primary health care (PHC) innovations, but also for their sustainability and scalability. For this evaluation, data collection was conducted using self-administered questionnaires and follow-up telephone interviews with team representatives. We used a combination of directed and conventional content analysis approaches to analyze the questionnaire and interview data. Representatives from all 12 teams completed the questionnaire and 11 teams participated in the interviews; 40 individuals participated in this evaluation. Four themes representing contextual factors that impacted the implementation of CBPHC innovations were identified: (I) diversity of jurisdictions (II) complexity of interactions and collaborations (III) policy, and (IV) the multifaceted nature of PHC. The teams used six strategies to address these contextual factors including: (1) conduct an environmental scan at the beginning (2) maintaining engagement among partners and stakeholders by encouraging open and inclusive communication; (3) contextualizing the innovation for different settings; (4) anticipating and addressing changes, delays, and the need for additional resources; (5) fostering a culture of research and innovation among partners and stakeholders; and (6) ensuring information about the innovation is widely available. Implementing CBPHC innovations across jurisdictions is complex and involves navigating through multiple contextual factors. Awareness of the dynamic nature of context should be considered when implementing innovations.
The ‘Portus Project’ investigates the social and economic contexts of the maritime port of Imperial Rome. This article presents the results of analysis of plant, animal and human remains from the site, and evaluates their significance for the reconstruction of the diets and geographic origins of its inhabitants between the second and sixth centuries AD. Integrating this evidence with other material from the recent excavations, including ceramic data, the authors identify clear diachronic shifts in imported foods and diet that relate to the commercial and political changes following the breakdown of Roman control of the Mediterranean.
With the emergence of modern techniques of environmental analysis and widespread availability of accessible tools and quantitative data, the question of environmental determinism is once again on the agenda. This paper is theoretical in character, attempting, for the benefit of drawing up research designs, to understand and evaluate the character of environmental determinism. We reach three main conclusions: (1) in a typical pattern of research design, studies seek to detect simultaneous shifts in the environmental and archaeological records, variously positing the former to have influenced, triggered or caused the latter; (2) the question of determinism involves uncertainty about the justification for the above research design in particular in what comes to biologism and the concept of environmental thresholds on the one hand and the externality of the drivers of transformation in human groups and societies on the other; (3) adapting the concepts of the social production of vulnerability and the social basis of hazards from anthropology may help to clarify the available research design choices at hand.
Childhood maltreatment (CM) plays an important role in the development of major depressive disorder (MDD). The aim of this study was to examine whether CM severity and type are associated with MDD-related brain alterations, and how they interact with sex and age.
Within the ENIGMA-MDD network, severity and subtypes of CM using the Childhood Trauma Questionnaire were assessed and structural magnetic resonance imaging data from patients with MDD and healthy controls were analyzed in a mega-analysis comprising a total of 3872 participants aged between 13 and 89 years. Cortical thickness and surface area were extracted at each site using FreeSurfer.
CM severity was associated with reduced cortical thickness in the banks of the superior temporal sulcus and supramarginal gyrus as well as with reduced surface area of the middle temporal lobe. Participants reporting both childhood neglect and abuse had a lower cortical thickness in the inferior parietal lobe, middle temporal lobe, and precuneus compared to participants not exposed to CM. In males only, regardless of diagnosis, CM severity was associated with higher cortical thickness of the rostral anterior cingulate cortex. Finally, a significant interaction between CM and age in predicting thickness was seen across several prefrontal, temporal, and temporo-parietal regions.
Severity and type of CM may impact cortical thickness and surface area. Importantly, CM may influence age-dependent brain maturation, particularly in regions related to the default mode network, perception, and theory of mind.
Background: Intensive care unit-acquired weakness (ICU-AW) is associated with poorer outcome of critically ill patients. Microcirculatory changes and altered vascular permeability of skeletal muscles might contribute to the pathogenesis of ICU-AW. Muscular ultrasound (MUS) displays increased muscle echogenicity, although its pathogenesis is uncertain. Objective: We investigated the combined measurement of serum and ultrasound markers to assess ICU-AW and clinical patient outcome. Methods: Fifteen patients and five healthy controls were longitudinally assessed for signs of ICU-AW at study days 3 and 10 using a muscle strength sum score. The definition of ICU-AW was based on decreased muscle strength assessed by the muscular research council-sum score. Ultrasound echogenicity of extremity muscles was assessed using a standardized protocol. Serum markers of inflammation and endothelial damage were measured. The 3-month outcome was assessed on the modified Rankin scale. Results: ICU-AW was present in eight patients, and seven patients and the control subjects did not develop ICU-AW. The global muscle echogenicity score (GME) differed significantly between controls and patients (mean GME, 1.1 ± 0.06 vs. 2.3 ± 0.41; p = 0.001). Mean GME values significantly decreased in patients without ICU-AW from assessment 1 (2.30 ± 0.48) to assessment 2 (2.06 ± 0.45; p = 0.027), which was not observed in patients with ICU-AW. Serum levels of syndecan-1 at day 3 significantly correlated with higher GME values at day 10 (r = 0.63, p = 0.012). Furthermore, the patients’ GME significantly correlated with mRS at day 100 (r = 0.67, p = 0.013). Conclusion: The combined use of muscular ultrasound and inflammatory biomarkers might be helpful to diagnose ICU-AW and to predict long-term outcome in critical illness.
Resting state functional magnetic resonance imaging studies have identified functional connectivity patterns associated with acute undernutrition in anorexia nervosa (AN), but few have investigated recovered patients. Thus, a trait connectivity profile characteristic of the disorder remains elusive. Using state-of-the-art graph–theoretic methods in acute AN, the authors previously found abnormal global brain network architecture, possibly driven by local network alterations. To disentangle trait from starvation effects, the present study examines network organization in recovered patients.
Graph–theoretic metrics were used to assess resting-state network properties in a large sample of female patients recovered from AN (recAN, n = 55) compared with pairwise age-matched healthy controls (HC, n = 55).
Indicative of an altered global network structure, recAN showed increased assortativity and reduced global clustering as well as small-worldness compared with HC, while no group differences at an intermediate or local network level were evident. However, using support-vector classifier on local metrics, recAN and HC could be separated with an accuracy of 70.4%.
This pattern of results suggests that long-term recovered patients have an aberrant global brain network configuration, similar to acutely underweight patients. While the finding of increased assortativity may represent a trait marker of AN, the remaining findings could be seen as a scar following prolonged undernutrition.
To describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources.
A pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.
A working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations.
Nineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team’s willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable.
There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal.
Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12).
In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%).
PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.
In this work, we propose an azimuthally-invariant periodic leaky-wave (LW) radiator for the generation of Bessel beams and X-waves by means of backward cylindrical LWs at millimeter wavelengths. A rigorous framework is first outlined to understand the theoretical constraints of such a novel design. A specific attention is devoted to the impact of the attenuation constant on the focusing properties of the generated Bessel beams. On this basis, a practical design is then proposed to meet the previous requirements. Numerical results for different frequency spectra confirm the interesting capabilities of the considered structure, paving the way for the first generation of nondiffracting pulses produced by focusing LWs.
This work addresses the piezoelectric induced reduction of quality factor in fully-printed metal-insulator-metal (MIM) barium strontium titanate (BST) thick film varactors designed for high power operation. An acoustically optimized varactor design is presented and compared to a non-optimized high-power varactor. The design is utilized to present a narrowband acoustic suppression technique based on defined weights. The acoustically optimized varactor consists of 162 varactor cells in a capacitive matrix. The cells in the matrix are interconnectable allowing for a variable unbiased capacitance and power rating. Due to this setup, surface acoustic waves are interrupted, and the reduced size of the cells allows for a reduced BST layer thickness, shifting the acoustic resonance away from the operational frequency. Therefore, an inverted behavior in comparison to the high-power varactor is observed with an increasing quality factor with biasing voltage. Compared to the high-power varactor, the acoustically optimized varactor design shows a 40% increased quality factor in biased state. By applying the narrowband acoustic suppression technique, an increase in quality factor of 145% is achieved compared to the unsuppressed design. In comparison to the high-power varactor, the acoustical suppressed design shows an increase in quality factor of 480% at the first acoustic resonance frequency.
Background: The importance of economic evaluation in decision making is growing with increasing budgetary pressures on health systems. Diverse economic evidence is available for a range of interventions across national contexts within Europe, but little attention has been given to identifying evidence gaps that, if filled, could contribute to more efficient allocation of resources. One objective of the Research Agenda for Health Economic Evaluation project is to determine the most important methodological evidence gaps for the ten highest burden conditions in the European Union (EU), and to suggest ways of filling these gaps.
Methods: The highest burden conditions in the EU by Disability Adjusted Life Years were determined using the Global Burden of Disease study. Clinical interventions were identified for each condition based on published guidelines, and economic evaluations indexed in MEDLINE were mapped to each intervention. A panel of public health and health economics experts discussed the evidence during a workshop and identified evidence gaps.
Results: The literature analysis contributed to identifying cross-cutting methodological and technical issues, which were considered by the expert panel to derive methodological research priorities.
Conclusions: The panel suggests a research agenda for health economics which incorporates the use of real-world evidence in the assessment of new and existing interventions; increased understanding of cost-effectiveness according to patient characteristics beyond the “-omics” approach to inform both investment and disinvestment decisions; methods for assessment of complex interventions; improved cross-talk between economic evaluations from health and other sectors; early health technology assessment; and standardized, transferable approaches to economic modeling.
Using dense networks of three-component seismometers installed in direct contact with the ice, the seismic activity of Gornergletscher, Switzerland, was investigated during the summers of 2004 and 2006, as subglacial water pressures varied drastically. These pressure variations are due to the diurnal cycle of meltwater input as well as the subglacial drainage of Gornersee, a nearby marginal ice-dammed lake. Up to several thousand seismic signals per day were recorded. Whereas most icequakes are due to surface crevasse openings, about 200 events have been reliably located close to the glacier bed. These basal events tend to occur in clusters and have signals with impulsive first arrivals. At the same time, basal water pressures and ice-surface velocities were measured to capture the impact of the lake drainage on the subglacial hydrological system and the ice-flow dynamics. Contrary to our expectations, we did not observe an increase of basal icequake activity as the lake emptied, thereby raising the subglacial water pressures close to the flotation level for several days. In fact, the basal icequakes were usually recorded during the morning hours, when the basal water pressure was either low or decreasing. During the high-pressure period caused by the drainage of the lake, no basal icequakes were observed. Furthermore, GPS measurements showed that the glacier surface was lowering during the basal seismic activity. These observations lead us to conclude that such icequakes are connected to the diurnal variation in glacier sliding across the glacier bed.
During summer 2011, seismic activity in the ablation zone of the western Greenland ice sheet (GrIS) was monitored using a network of three-component seismometers. The seismic record includes a large variety of icequakes and seismic tremors that demonstrate a clear correlation with subglacial water flow. We verified the existence of well-known shallow icequakes (related to surface crevasse formation), deep icequakes (located at 100–160 m depth) and narrow-banded short-term seismic tremors (tens of seconds in duration). In addition, we present previously unreported long-term tremors lasting several hours. Using attenuation of the measured tremor amplitude, we locate the epicentre of this long-term tremor to a large moulin within our study area. Between 3 and 11 Hz, our continuous seismic record is dominated by this ‘moulin tremor’ and shows strong correlation with the water level of the generating moulin. We argue that monitoring of icequake and glacial tremor sources bears high potential for investigating glacier hydraulics and dynamics, and is thus an ideal supplement to traditional glaciological measurements.
Objectives: Pedophilia (P) is a psychiatric disease associated with sexual attraction toward children and often accompanied by child sexual offending (CSO). Consequently, it is important to address the understanding of executive dysfunctions that may increase the probability of CSO. Moreover, this research field has been lacking to disentangle executive deficits associated with pedophilia (as a deviant sexual preference) from those associated with CSO (as a deviant sexual behavior). Methods: The German multi-sided research network NeMUP offers the opportunity to overcome these limitations. By applying the Cambridge Automated Neuropsychological Test Battery in four carefully matched groups of men: (1) pedophiles with (N=45) and (2) without (N=45) a history of sexual offending against children; (3) child molesters without pedophilia (N=19), and (4) non-offending controls (N=49), we were able to analyze executive functioning in pedophilia and CSO independently. Results: Both CSO groups as compared to both non-CSO groups exhibited worsened response inhibition ability. However, only non-pedophilic offenders showed additionally disabled strategy use ability. Regarding set-shifting abilities, the P+CSO group showed the best performance. We also found that performances were affected by age: only in pedophiles, response inhibition worsened with age, while age-related deficits in set-shifting abilities were restricted to non-pedophilic participants. The latter also differentiated between both sexual preference groups. Conclusions: Our results are the first to demonstrate that executive dysfunctions are related to offense status rather than pedophilic preference. Furthermore, there was evidence for differentiating age and performance correlations between pedophiles and non-pedophiles, which warrants further investigation. (JINS, 2017, 23, 460–470)
Dating ice samples from glaciers via radiocarbon is a challenge that requires systematic investigations. This work describes an approach for extraction and accelerator mass spectrometry (AMS) 14C analysis of the particulate organic carbon (POC) fraction in glacier ice samples. Measurements were performed at VERA (Vienna Environmental Research Accelerator) on ice samples obtained mainly from the non-temperated ablation zone of the Grenzgletscher (Grenz Glacier) system (Monte Rosa Massif, Swiss Alps). The samples were obtained from 2 sampling sites situated roughly on a common flow line. The sample masses used were between 0.3 and 1.4 kg of ice, yielding between 18 and 307 μg of carbon as POC. The carbon contamination introduced during sample processing varied between 5.4 and 33 μg C and originated mainly from the quartz filters and the rinsing liquids used in processing. Minimum sample sizes for successful graphitization of CO2 in our laboratory could be reduced to <10 μg carbon, with a background in the graphitization process of ∼0.5 μg of 40-pMC carbon. Evaluation of the whole procedure via 11 Grenzgletscher samples revealed a surprisingly large scatter of pMC values. We obtain a mean calibrated age of 2100 BC to AD 900 (95.4% confidence level), which is not significantly different for the 2 sampling sites. Discussions of these results suggest that single 14C dates of glacial POC are presently of limited significance. Future improvements with respect to analytical precision and sample characterization are proposed in order to fully explore the POC dating potential.
We report the discovery of extended star formation in the prominent tidal arms near NGC 3077 (member of the M 81 triplet). 36 faint compact star forming regions were identified, covering an area of 4 × 6 kpc2. HII regions are only found near the southern rim of the tidal HI arm where the HI column density reaches values above 1 × 1021 cm−2. This threshold is very similar to what is found in ‘normal’ galactic environments. We derive a total star formation rate of 2.6 × 10−3M⊙ yr−1 in the tidal feature. We also present the first high-resolution observations of molecular gas in this region. The molecular gas emission can be separated into at least 5 distinct complexes most of which do not coincide with sites of star formation. The reservoir of neutral and molecular gas in the tidal arm is huge (~5 × 108M⊙); star formation may continue at the given rate for a Hubble time. We conclude that wide-spread low-level star formation may be a common phenomenon in tidal HI tails, however it will be difficult to detect in interacting systems that are further away.
Deep Chandra observations of NGC 3077, a starburst dwarf galaxy in the M81 triplet, resolve the X-ray emission from several supershells. The emission is brightest in the cavities defined by expanding shells detected previously in Hα emission. Thermal emission models fitted to the data imply temperatures ranging from 1.3 to 4.9 × 106 K. The total 0.3–6.0 keV X-ray luminosity is 2 − 5 × 1039ergs−1 (depending on the selected thermal plasma model). Most (85%) of the X-ray luminosity in NGC 3077 comes from the hot interstellar gas; the remainder comes from six X-ray point sources. The radial density profile of the hot gas is not as steep as that expected in a freely expanding wind (e.g., as seen in the neighboring starburst galaxy M 82) implying that the hot gas is still confined by the Hα shells.
From our recent Faint Object Spectrograph (FOS) observations of the Orion Nebula obtained with the Hubble Space Telescope, we present preliminary results that address the nitrogen abundance. The list of detected lines and their identifications included the first measurement of the N II] 2142 Å line in an H II region. This measurement in conjunction with [O II] 2471 Å permits a new assessment of the important N/O ratio in Orion. Unfortunately, the measurements of the N III] 1747-54 Å multiplet and the O III] 1660-66 Å multiplet have poor signal-to-noise, precluding another independent derivation of N/O.