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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.
Introduction: Identification of latent safety threats (LSTs) in the emergency department is an important aspect of quality improvement that can lead to improved patient care. In situ simulation (ISS) takes place in the real clinical environment and multidisciplinary teams can participate in diverse high acuity scenarios to identify LSTs. The purpose of this study is to examine the influence that the profession of the participant (i.e. physician, registered nurse, or respiratory therapist) has on the identification of LSTs during ISS. Methods: Six resuscitation- based adult and pediatric simulated scenarios were developed and delivered to multidisciplinary teams in the Kingston General Hospital ED. Each ISS session consisted of a 10- minute scenario, followed by 3-minutes of individual survey completion and a 7- minute group debrief led by ISS facilitators. An objective assessor recorded LSTs identified during each debrief. Surveys were completed prior to debrief to reduce response bias. Data was collected on participant demographics and perceived LSTs classified in the following categories: medication; equipment; resources and staffing; teamwork and communication; or other. Two reviewers evaluated survey responses and debrief notes to formulate a list of unique LSTs across scenarios and professions. The overall number and type of LSTs from surveys was identified and stratified by health care provider. Results: Thirteen ISS sessions were conducted with a total of 59 participants. Thirty- four unique LSTs (8 medication, 15 equipment, 5 resource, 4 communication, and 2 miscellaneous issues) were identified from surveys and debrief notes. Overall, MDs (n = 12) reported 19 LSTss (n = 41) reported 77 LSTs, and RTs (n = 6) reported 4 LSTs based on individual survey data. The most commonly identified category of LSTs reported by MDs (36.8%) and RTs (75%) was equipment issues while RNs most commonly identified medication issues (36.4%). Participants with □5 years of experience in their profession, on average identified more LSTs in surveys than participants with >5 years experience (1.9 LSTs vs 1.5 LSTs respectively). Conclusion: Nursing staff identified the highest number of LSTs across all categories. There was fairly unanimous identification of major LSTs across professions, however each profession did identify unique perspectives on LSTs in survey responses. ISS programs with the purpose of LST identification would benefit from multidisciplinary participation.
In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR = 1.49, p = 0.008), NAS abuse (PR = 2.06, p = 0.02) and IPV (PR = 2.93, p < 0.001) were significantly associated with DS. Older age [odds ratio (OR) = 0.31, p < 0.001)], female (OR = 0.48, p = 0.036) were protective of NAS but current smokers (OR = 2.98, p < 0.001) and those reporting IPV (OR = 2.16, p = 0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.
This Research Communication describes an investigation of the nutritional depletion of total mixed rations (TMR) by pest birds. We hypothesized that species-specific bird depredation of TMR can alter the nutritional composition of the ration and that these changes can negatively impact the performance of dairy cows. Blackbirds selected the high energy fraction of the TMR (i.e., flaked corn) and reduced starch, crude fat and total digestible nutrients during controlled feeding experiments. For Holsteins producing 37·1 kg of milk/d, dairy production modeling illustrated that total required net energy intake (NEI) was 35·8 Mcal/d. For the reference TMR unexposed to blackbirds and the blackbird-consumed TMR, NEI supplied was 41·2 and 37·8 Mcal/d, and the resulting energy balance was 5·4 and 2·0 Mcal/d, respectively. Thus, Holsteins fed the reference and blackbird-consumed TMR were estimated to gain one body condition score in 96 and 254 d, and experience daily weight change due to reserves of 1·1 and 0·4 kg/d, respectively. We discuss these results in context of an integrated pest management program for mitigating the depredation caused by pest birds at commercial dairies.
To identify predominant dietary patterns in four African populations and examine their association with obesity.
We used data from the Africa/Harvard School of Public Health Partnership for Cohort Research and Training (PaCT) pilot study established to investigate the feasibility of a multi-country longitudinal study of non-communicable chronic disease in sub-Saharan Africa. We applied principal component analysis to dietary intake data collected from an FFQ developed for PaCT to ascertain dietary patterns in Tanzania, South Africa, and peri-urban and rural Uganda. The sample consisted of 444 women and 294 men.
We identified two dietary patterns: the Mixed Diet pattern characterized by high intakes of unprocessed foods such as vegetables and fresh fish, but also cold cuts and refined grains; and the Processed Diet pattern characterized by high intakes of salad dressing, cold cuts and sweets. Women in the highest tertile of the Processed Diet pattern score were 3·00 times more likely to be overweight (95 % CI 1·66, 5·45; prevalence=74 %) and 4·24 times more likely to be obese (95 % CI 2·23, 8·05; prevalence=44 %) than women in this pattern’s lowest tertile (both P<0·0001; prevalence=47 and 14 %, respectively). We found similarly strong associations in men. There was no association between the Mixed Diet pattern and overweight or obesity.
We identified two major dietary patterns in several African populations, a Mixed Diet pattern and a Processed Diet pattern. The Processed Diet pattern was associated with obesity.
We present Kitty, an unprecedented and near simultaneous flaring event in ten transitions (6 hydroxyl, 1 water and 3 methanol), that began on 1 January 2015 in the massive star-forming region NGC6334F located in the Cat’s Paw Nebula. The brightest components in each transition increased by factors of 20 to 70 in line with a factor of ~70 increase in dust emission luminosity for the source MM1. We also report the detection of only the fifth known 4.660 GHz hydroxyl maser and that it varied in a correlated fashion with 1.720, 6.031, and 6.035 GHz hydroxyl counterparts. We postulate that if Kitty, and two historical flares in 1965 & 1999, are accretion events and are caused by the successive passages of a secondary star disrupting the accretion disk, where the frequency of occurrence is cycling down at a rate of ~2.2, it is possible another event will occur in 2022.
We report the discovery of widespread millimeter-wavelength Class I methanol maser emission associated with protostellar molecular outflows in the massive (proto)cluster G11.92−0.61. Our ~0.5″-resolution SMA and ALMA observations of the 229 GHz and 278 GHz Class I transitions reveal seven and twelve candidate masers, respectively: all 229 GHz masers have 278 GHz counterparts, and five are also coincident with 44 GHz Class I masers previously detected with the VLA. For paired masers, the peak intensities at 229 GHz and 278 GHz are correlated. We also find tentative evidence for a correlation between the strength of millimeter-wavelength Class I maser emission and the energy of the associated molecular outflow.
The final stages of low-mass stellar evolution are characterized by significant mass loss due to stellar pulsations during the AGB phase, which lead to the development of planetary nebulae. Molecular masers of H2O, SiO, and ground state OH transitions are commonly detected in oxygen-rich late-type stars (OH/IR objects). In contrast, excited OH maser transitions are rare. We discuss our study of the carbon-rich pre-planetary nebula CRL618 (a prototypical post-AGB star). Observations conducted in May 2008 with the 305m Arecibo Telescope resulted in the first detection of a 4765MHz OH maser line in a late-type stellar object; the detection was confirmed a few months later also with Arecibo. Subsequent observations in 2015 and 2017 resulted in non-detection of the 4765MHz OH line. Our observations indicate that the 4765MHz OH maser in CRL 618 is highly variable, possibly tracing a short-lived phenomenon during the development of a pre-planetary nebula.
The Central Molecular Zone (CMZ), the inner 450 pc of our Galaxy, is an exceptional region where the volume and column densities, gas temperatures, velocity dispersions, etc. are much higher than in the Galactic plane. It has been suggested that the formation of stars and clusters in this area is related to the orbital dynamics of the gas. The complex kinematic structure of the molecular gas was revealed by spectral line observations. However, these results are limited to the line-of-sight-velocities. To fully understand the motions of the gas within the CMZ, we have to know its location in 6D space (3D location + 3D motion). Recent orbital models have tried to explain the inflow of gas towards and its kinematics within this region. With parallax and proper motion measurements of masers in the CMZ we can discriminate among these models and constrain how our Galactic Center is fed with gas.
The full theory of polarized SiO maser emission from the near-circumstellar environment of Asymptotic Giant Branch stars has been the subject of debate, with theories ranging from classical Zeeman origins to predominantly non-Zeeman anisotropic excitation or propagation effects. Features with an internal electric vector position angle (EVPA) rotation of ∼π/2 offer unique constraints on theoretical models. In this work, results are presented for one such feature that persisted across five epochs of SiO ν = 1, J = 1 − 0 VLBA observations of TX Cam. We examine the fit to the predicted dependence of linear polarization and EVPA on angle (θ) between the line of sight and the magnetic field against theoretical models. We also present results on the dependence of mc on θ and their theoretical implications. Finally, we discuss potential causes of the observed differences, and continuing work.
We initiated a long-term and highly frequent monitoring project toward 442 methanol masers at 6.7 GHz (Dec >−30 deg) using the Hitachi 32-m radio telescope in December 2012. The observations have been carried out daily, monitoring a spectrum of each source with intervals of 9–10 days. In September 2015, the number of the target sources and intervals were redesigned into 143 and 4–5 days, respectively. This monitoring provides us complete information on how many sources show periodic flux variations in high-mass star-forming regions, which have been detected in 20 sources with periods of 29.5–668 days so far (e.g., Goedhart et al. 2004). We have already obtained new detections of periodic flux variations in 31 methanol sources with periods of 22–409 days. These periodic flux variations must be a unique tool to investigate high-mass protostars themselves and their circumstellar structure on a very tiny spatial scale of 0.1–1 au.
We present the results from the Australian Long Baseline Array (LBA) observations of the ground- and excited-state OH masers at high resolutions towards the massive star-forming region G351.417+0.645 in 2012. We obtain the most accurate spatial gradient of magnetic fields at ground state transitions and verify the reliability of magnetic field strengths measured from previous lower resolution observations. In comparison with previous LBA observations in 2001 at 6.0 GHz, we identified several matched Zeeman pairs. We found that the OH maser features have no significant change of magnetic field strengths and directions with small internal proper motions, implying quite stable physical conditions. Additionally, we found that 1665- and 6035-MHz OH maser features reveal the same trend of reversal of magnetic fields. Moreover, we also analyzed the physical conditions at different locations from the coincidence of different OH maser transitions based on current OH maser models.
We present a case study of a single high-mass protostar associated with an infrared quiet massive clump selected from the ATLASGAL survey. The thermal dust emission reveals a single collapsing object associated with a prominent molecular outflow. We detect bright emission from a torsionally excited state transition of CH3OH offset from the protostar that is well explained by shocks at the transition from the infalling envelope onto an accretion disk.
We present the results of the first detection of submillimeter water maser emission toward water-fountain nebulae. Using APEX we found emission at 321.226 GHz toward two sources: IRAS 18043−2116, and IRAS 18286−0959. The submillimeter H2O masers exhibit expansion velocities larger than those of the OH masers, suggesting that these masers, similarly to the 22 GHz masers, originate in fast bipolar outflows. The 321 GHz masers in IRAS 18043−2116 and IRAS 18286−0959, which figure among the sources with the fastest H2O masers, span a velocity range similar to that of the 22 GHz masers, indicating that they probably coexist. The intensity of the submillimeter masers is comparable to the 22 GHz masers, implying that the kinetic temperature of the region where the masers originate is Tk>1000 K. We propose a simple model invoking the passage of two shocks through the same gas that creates the conditions for explaining the strong high-velocity 321 GHz masers coexisting with the 22 GHz masers in the same region.
Theoretical simulations have shown that magnetic fields play an important role in massive star formation: they can suppress fragmentation in the star forming cloud, enhance accretion via disc and regulate outflows and jets. However, models require specific magnetic configurations and need more observational constraints to properly test the impact of magnetic fields. We investigate the magnetic field structure of the massive protostar IRAS18089-1732, analysing 6.7 GHz CH3OH maser MERLIN observations. IRAS18089-1732 is a well studied high mass protostar, showing a hot core chemistry, an accretion disc and a bipolar outflow. An ordered magnetic field oriented around its disc has been detected from previous observations of polarised dust. This gives us the chance to investigate how the magnetic field at the small scale probed by masers relates to the large scale field probed by the dust.
Through the observations and the analysis of maser polarization it is possible to measure the magnetic field in several astrophysical environments (e.g., star-forming regions, evolved stars). In particular from the linearly and circularly polarized emissions we can determine the orientation and the strength of the magnetic field, respectively. In these proceedings the implications, on observed data, of the new estimation of the Landé g-factors for the CH3OH maser are presented. Furthermore, some example of the most recent results achieved in observing the polarized maser emission from several maser species will also be reported.
The formation process of high-mass stars has puzzled the astrophysical community for decades from both a theoretical and an observational point of view. Here, we present an overview of the current theories and status of the observational research on this field, outlining the progress achieved in recent years on our knowledge of the initial phases of massive star formation, the fragmentation of cold, infrared-dark clouds, and the evidence for circumstellar accretion disks around OB stars. The role of masers in helping us to understand the mechanism leading to the formation of a high-mass star are also discussed.
The galaxy M87 (3C274, NGC4486) contains one of the nearest jet sources in the northern hemisphere, and one of our best opportunities to study a jet in detail. We have made MkII VLBI observations of the nuclear jet at 1.66 GHz using 18 stations of the “World Array.” The array included Arecibo which greatly improved the north-south resolution. The data were global fringe fitted, and self-calibrated to remove both antenna and baseline amplitude and phase errors. The resulting map (Fig. 1) has a dynamic range of 2300:1 and reveals a very complex structure. At distances ≥50 mas from the core, the jet is resolved across its width and appears limb-brightened. The brightness centroid oscillates from side to side by an amount roughly equal to the jet's width; this may be caused by brightness variations at the edges of a limb-brightened jet. Within 50 mas of the core the opening angle (at the FWHM points) is 6.5°±0.3°; this is larger than that of the 20″ jet, and suggests there is recollimation between the pc and kpc scales. The jet is aligned within 1° of the 20″ jet. There is no evidence for a counter-jet; the jet/counter-jet brightness ratio is R≥200.
Halophilic Archaea are known to tolerate multiple extreme conditions on Earth and have been proposed as models for astrobiology. In order to assess the importance of cold-adaptation of these microorganisms in surviving stratospheric conditions, we launched live, liquid cultures of two species, the mesophilic model Halobacterium sp. NRC-1 and the cold-adapted Antarctic isolate Halorubrum lacusprofundi ATCC 49239, on helium balloons. After return to Earth, the cold-adapted species showed nearly complete survival while the mesophilic species exhibited slightly reduced viability. Parallel studies found that the cold-adapted species was also better able to survive freezing and thawing in the laboratory. Genome-wide transcriptomic analysis was used to compare the two haloarchaea at optimum growth temperatures versus low temperatures supporting growth. The cold-adapted species displayed perturbation of a majority of genes upon cold temperature exposure, divided evenly between up-regulated and down-regulated genes, while the mesophile exhibited perturbation of only a fifth of its genes, with nearly two-thirds being down-regulated. These results underscore the importance of genetic responses of H. lacusprofundi to cold temperature for enhanced survival in the stratosphere.