Planning and developing services for diabetic retinopathy in Sub-Saharan Africa

Background: Over the past few decades diabetes has emerged as an important non-communicable disease in Sub- Saharan Africa (SSA). Sight loss from Diabetic Retinopathy (DR) can be prevented with screening and early treatment. The objective of this paper is to outline the required actions and considerations in the planning and development of DR screening services. Methods: A multiple-case study approach was used to analyse five DR screening services in Botswana, Ghana, Tanzania and Zambia. Cases included: two regional screening programmes, two hospital-based screening services and one nationwide screening service. Data was collected using qualitative methodologies including: document analysis, in- depth interviews and observation. The World Health Organization (WHO) Health Systems Framework was adopted as the conceptual framework for analysis. Results: Planning for a sustainable and integrated DR screening programme demanded a health systems approach. Collaboration with representatives from a variety of ministerial departments and professional bodies was required. Evolution of DR screening services may occur in a variety of ways including: increasing geographical coverage, integration into the general healthcare system, and stepwise progression from a passive, opportunistic service to one that systematically and proactively seeks to prevent DR. Lessons learned from the implementation of cervical cancer prevention programmes in resource-poor settings may assist the development of DR programmes in similar settings. Conclusion: To promote good planning of DR screening services and ensure limited resources are used effectively, there is a need to learn from screening programmes in other medical specialities and a need to share experiences between newly-developing DR programmes in resource-poor countries. The WHO Health Systems Framework presents an invaluable tool to ensure a systematic approach to planning DR screening service

Evidence for a role of Arabidopsis CDT1 proteins in gametophyte development and maintenance of genome integrity

Meristems retain the ability to divide throughout the life cycle of plants, which can last for over 1000 years in some species. Furthermore, the germline is not laid down early during embryogenesis but originates from the meristematic cells relatively late during development. Thus, accurate cell cycle regulation is of utmost importance to avoid the accumulation of mutations during vegetative growth and reproduction. The Arabidopsis thaliana genome encodes two homologs of the replication licensing factor CDC10 Target1 (CDT1), and overexpression of CDT1a stimulates DNA replication. Here, we have investigated the respective functions of Arabidopsis CDT1a and CDT1b. We show that CDT1 proteins have partially redundant functions during gametophyte development and are required for the maintenance of genome integrity. Furthermore, CDT1-RNAi plants show endogenous DNA stress, are more tolerant than the wild type to DNA-damaging agents, and show constitutive induction of genes involved in DNA repair. This DNA stress response may be a direct consequence of reduced CDT1 accumulation on DNA repair or may relate to the ability of CDT1 proteins to form complexes with DNA polymerase e, which functions in DNA replication and in DNA stress checkpoint activation. Taken together, our results provide evidence for a crucial role of Arabidopsis CDT1 proteins in genome stability

Factors affecting feelings of justice in biodiversity conflicts : towards fairer jaguar management in Calakmul, Mexico

Funding was provided by Mitacs through a Globalink Research Award to MLL, BS and SC, a José-Sarukhan Excellence Award given by the Centro del Cambio Global y Sustentabilidad del Sureste to MLL, an Excellence Award from the Quebec Center for Biodiversity Science to MLL, and a grant from the Université de Sherbrooke to SC.Conservation focuses on environmental objectives, but neglecting social concerns can lead to feelings of injustice among some actors and thus jeopardise conservation aims. Through a case study on a biodiversity conflict around jaguar management in Southern Mexico, we explored actors' feelings of injustice and their associated determinants. We employed a framework distinguishing four dimensions of justice: recognition, ecological, distributive and procedural. By conducting and analysing 235 interviews with farmers and ranchers, we investigated what drive their feeling of injustice, namely their perceptions of the injustice itself, individual characteristics and interactions with their environment. The participants selected 10 statements representing criteria characterizing their feeling of justice toward jaguar management, which they compared using pair-wise comparisons. A pioneering statistical analysis, BTLLasso, revealed that self-interest assumptions were not upheld; feelings of injustice were only weakly influenced by experience of depredation. Feelings of injustice were influenced mainly by factors related to actors' intra-and inter-group relationships (e.g. perception of collective responsibility, perceived coherence in the group to which they identified). This nuanced understanding of how people build their perception of justice can inform fairer and more effective conservation approaches. Whilst details will be context specific, it emerged that building relationships and enabling debate over ecological responsibilities are important and conservation efforts should go beyond merely offering financial compensation. We conclude that perception of justice is a neglected but important aspect to include in integrative approaches to managing biodiversity conflicts, and that novel mixed methods can advance both conceptual and applied understanding in this area.PostprintPeer reviewe

POLÍTICAS EN ENFERMERÍA: UN APRENDIZAJE ESENCIAL PARA ALUMNOS DE POSGRADO

In Canada, as elsewhere, nurses must face many challenges if they want to participate as an influential group within health care organizations, but there are some facilitators; among them are the ability to analyze the context, issues and the right course of actions from a political perspective. This article shares the learning outcomes of postgraduate students during a seminar on policies related to nursing services administration at Université Laval, Québec, Canada. The aim of this article is to present the learning achieved from themes and issues discussed in the seminar and introduce tools for political analysis that are useful to draw the current state of nursing in the healthcare system. At the end of the seminar, the learning achieved allowed students to comprehend different elements that must be taken into account to assess the current situation concerning important issues for the nursing profession and consider courses of action to influence their evolution. No Canadá, como em outros lugares, enfermeiros devem enfrentar muitos desafios caso queiram participar como umgrupo que influencia em organizações de cuidados em saúde. Contudo, existem alguns facilitadores, entre eles estão a habilidade deanalisar o contexto, assuntos e percurso correto de ações sob a perspectiva política. Este artigo compartilha o resultado de aprendizado de estudantes de pós-graduação durante um seminário em politicas relacionadas aos serviços de administração de enfermagem na Universidade Laval, Quebec, Canadá. O objetivo deste artigo é apresentar o aprendizado alcançado sobre temas e assuntos discutidos e introduzir ferramentas para análise política, úteis para descrever a atual posição de enfermagem no sistema de saúde. No final do seminário, o aprendizado permitiu aos estudantes compreender diferentes elementos que devem ser considerados para avaliar a atual situação no que diz respeito a assuntos importantes para a profissão, e considerar percursos de ação para influenciar seu desenvolvimento.En Canadá, como en otros sitios, enfermeros deben pasar por muchos desafíos si desean participar como un grupo queinfluencia organizaciones de cuidados en salud. Sin embargo, hay algunos facilitadores, entre los cuales están la habilidad de analizarel contexto, asuntos y camino correcto de acciones bajo la perspectiva política. Este artículo comparte el resultado del aprendizaje deestudiantes de posgrado durante un congreso de políticas relacionadas a los servicios de administración de enfermería en la UniversidadLaval, Quebec, Canadá. El objetivo del artículo fue presentar el aprendizaje alcanzado acerca de temas y asuntos discutidos así comointroducir herramientas para análisis político, útiles para describir la actual posición de la enfermería en el sistema de salud. En elfinal del evento, el aprendizaje permitió a los estudiantes comprender diferentes elementos que deben ser considerados para evaluarla actual situación acerca de asuntos importantes para la profesión, y considerar caminos de acción para influenciar su desarrollo

Normative data for the dementia rating scale in the french-Quebec population

The Dementia Rating Scale-2 is used to measure cognitive status of adults with cognitive impairment, especially of the degenerative type, by assessing five cognitive functions, namely attention, initiation/perseveration, construction, conceptualization, and memory. The present study aimed to establish normative data for this test in the elderly French-Quebec population. A total of 432 French-speaking elders from the province of Quebec (Canada), aged 50 to 85 years, were administered the Dementia Rating Scale-2. Age and education were found to be associated with the total score on the test, while gender was not. Percentile ranks were then calculated for age- and education-stratified groups. Previous studies have shown that cultural background can affect performance on the DRS and the development of culture-specific norms for French-speaking Quebecers could be very useful to clinicians and researchers working with this population

A mixed methods protocol to evaluate the effect and cost-effectiveness of an Integrated electronic Diagnosis Approach (IeDA) for the management of childhood illnesses at primary health facilities in Burkina Faso.

BACKGROUND: Burkina Faso introduced the Integrated Management of Childhood Illnesses (IMCI) strategy in 2003. However, an evaluation conducted in 2013 found that only 28 % of children were assessed for three danger signs as recommended by IMCI, and only 15 % of children were correctly classified. About 30 % of children were correctly prescribed with an antibiotic for suspected pneumonia or oral rehydration salts (ORS) for diarrhoea, and 40 % were correctly referred. Recent advances in information and communication technologies (ICT) and use of electronic clinical protocols hold the potential to transform healthcare delivery in low-income countries. However, no evidence is available on the effect of ICT on adherence to IMCI. This paper describes the research protocol of a mixed methods study that aims to measure the effect of the Integrated electronic Diagnosis Approach innovation (an electronic IMCI protocol provided to nurses) in two regions of Burkina Faso. METHODS/DESIGN: The study combines a stepped-wedge trial, a realistic evaluation and an economic study in order to capture the effect of the innovation after its introduction on the level of adherence, cost and acceptability. DISCUSSION: The main challenge is to interconnect the three substudies. In integrating outcome, process and cost data, we focus on three key questions: (i) How does the effectiveness and the cost of the intervention vary by type of health worker and type of health centre? (ii) What is the impact of changes in the content, coverage and quality of the IeDA intervention on adherence and cost-effectiveness? (iii) What mechanisms of change (including costs) might explain the relationship between the IeDA intervention and adherence? TRIAL REGISTRATION: Clinicaltrials.gov, NCT02341469

Enhancing Flood Forecasting with Dual State-Parameter Estimation and Ensemble-based SAR Data Assimilation

Hydrodynamic

Protons accumulation during anodic phase turned to advantage for oxygen reduction during cathodic phase in reversible bioelectrodes

Reversible bioelectrodes were designed by alternating acetate and oxygen supply. It was demonstrated that the protons produced and accumulated inside the biofilm during the anodic phase greatly favored the oxygen reduction reaction when the electrode was switched to become the biocathode. Protons accumulation, which hindered the bioanode operation, thus became an advantage for the biocathode. The bioanodes, formed from garden compost leachate under constant polarization at −0.2 V vs. SCE, were able to support long exposure to forced aeration, with only a slight alteration of their anodic efficiency. They produced a current density of 16 ± 1.7 A/m2 for acetate oxidation and up to −0.4 A/m2 for oxygen reduction. Analysis of the microbial communities by 16S rRNA pyrosequencing revealed strong selection of Chloroflexi (49 ± 1%), which was not observed for conventional bioanodes not exposed to oxygen. Chloroflexi were found as the dominant phylum of electroactive biofilms for the first time

Realistic Evaluation of the Integrated Electronic Diagnosis Approach (IeDA) for the Management of Childhood Illnesses at Primary Health Facilities in Burkina Faso

Background: In 2014, Terre des Hommes (Tdh) together with the Ministry of Health (MoH) launched the Integrated electronic Diagnosis Approach (IeDA) intervention in two regions of Burkina Faso consisting of supplying every health centre with a digital algorithm. A realistic evaluation was conducted to understand the implementation process, the mechanisms by which the IeDA intervention lead to change. Methods: Data collection took place between January 2016 and October 2017. Direct observation in health centres were conducted. In-depth interviews were conducted with 154 individuals including 92 healthcare workers (HCW) from health centres, 16 officers from district health authorities, 6 members of health centre management committees. In addition, 5 focus groups were organised with carers. The initial coding was based on a preliminary list of codes inspired by the Middle Range Theory. Results: Our results showed that the adoption of the electronic protocol depended on a multiplicity of management practices including role distribution, team work, problem solving approach,task monitoring,training, supervision, support and recognition. Such changes lead to reorganising the health team and redistributing roles before and during consultation, and positive atmosphere that included recognition of each team member, organisational commitment and sense of belonging. Conditions for such management changes to be effective included open dialog at all levels of the system, a minimum of resources to cover the support services and supervision and regular discussions focusing on solving problems faced by health centre teams. Conclusion: This project reinforces the point that in a successful diffusion of IeDA, it is necessary to combine the introduction of technology with support and management mechanisms. It also important to highlight that managers’ attitude plays a great place in the success of the intervention: open dialog and respect are crucial dimensions. This is aligned with the findings from other studies

Health system resilience: a critical review and reconceptualisation

This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and—as amply shown during the COVID-19 pandemic—relationships with wider systems (eg, economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. We discourage the framing of resilience as an outcome that can be measured; instead, we see it emerge from systemic resources and interactions, which have effects that can be measured. We propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. We encourage a shift in thinking from capacities towards capabilities—what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, we highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance