The role of global public health strategy in non-profit organisational change at country level: lessons from the joining of Save the Children and Merlin in Myanmar.

INTRODUCTION: The paper presents a case study that critically assesses the role of global strategy 'Public Health on the Frontline 2014-2015' ('the Strategy') in supporting Merlin and Save the Children's organisational change and future programme of the combined organisation in Myanmar. MATERIALS AND METHODS: Research was undertaken in 2014 in Myanmar. Twenty-six individual and three group interviews were conducted with stakeholders, and 10 meetings relevant to the country organisational transition process were observed. A conceptual framework was developed to assess the role of the global strategy in supporting the country change process. RESULTS: Several positive aspects of the global strategy were found, as well as critical shortcomings in its support to the organisational change process at country level. The strategy was useful in signalling Save the Children's intention to scale up humanitarian health provision. However, it had only limited influence on the early change process and outcomes in Myanmar. CONCLUSIONS: Results highlight several aspects that would enhance the role of a global strategy at country level. Lessons can be applied by organisations undertaking a similar process. Copyright © 2016 John Wiley & Sons, Ltd

Giving Unto Others: Private Financial Transfers and Hardship Among Families With Children

Prior research shows that financial assistance from family and friends is an important source of support for families with children. Research on financial transfers has largely focused on the recipients of transfers, however. In this study, using longitudinal data from the Fragile Families and Child Wellbeing Study (n ∼ 16,000 person‐waves), the authors examine the association between the provision of financial assistance to family and friends and material hardship. The results from pooled regression and fixed effects models indicate that providing financial transfers is associated with an increased risk of hardship. The most economically disadvantaged groups, single mothers, those in the bottom income tertile, and Black mothers are the most likely to experience hardship after giving a transfer. These findings have important implications for understanding why families may have difficulty meeting basic and essential needs and how social networks may exacerbate the challenges of escaping poverty and establishing economic self‐sufficiency.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136679/1/jomf12392_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136679/2/jomf12392.pd

Overexpression of Mcl-1 exacerbates lymphocyte accumulation and autoimmune kidney disease in lpr mice

Cell death by apoptosis has a critical role during embryonic development and in maintaining tissue homeostasis. In mammals, there are two converging apoptosis pathways: the ‘extrinsic’ pathway, which is triggered by engagement of cell surface ‘death receptors’ such as Fas/APO-1; and the ‘intrinsic’ pathway, which is triggered by diverse cellular stresses, and is regulated by prosurvival and pro-apoptotic members of the Bcl-2 family of proteins. Pro-survival Mcl-1, which can block activation of the proapoptotic proteins, Bax and Bak, appears critical for the survival and maintenance of multiple haemopoietic cell types. To investigate the impact on haemopoiesis of simultaneously inhibiting both apoptosis pathways, we introduced the vavP-Mcl-1 transgene, which causes overexpression of Mcl-1 protein in all haemopoietic lineages, into Faslpr/lpr mice, which lack functional Fas and are prone to autoimmunity. The combined mutations had a modest impact on myelopoiesis, primarily an increase in the macrophage/monocyte population in Mcl-1tg/lpr mice compared with lpr or Mcl-1tg mice. The impact on lymphopoiesis was striking, with a marked elevation in all major lymphoid subsets, including the non-conventional double-negative (DN) T cells (TCRβ+ CD4– CD8– B220+ ) characteristic of Faslpr/lpr mice. Of note, the onset of autoimmunity was markedly accelerated in Mcl-1tg/lpr mice compared with lpr mice, and this was preceded by an increase in immunoglobulin (Ig)-producing cells and circulating autoantibodies. This degree of impact was surprising, given the relatively mild phenotype conferred by the vavP-Mcl-1 transgene by itself: a two- to threefold elevation of peripheral B and T cells, no significant increase in the non-conventional DN T-cell population and no autoimmune disease. Comparison of the phenotype with that of other susceptible mice suggests that the development of autoimmune disease in Mcl-1tg/lpr mice may be influenced not only by Ig-producing cells but also other haemopoietic cell types

A Meta-ethnography of Qualitative Accounts of Personal Recovery from Depression and, a Qualitative Study Exploring Engagement in the Early Stages of Psychotherapy for Depression

This thesis consists of a literature review and research study. The literature review employed a meta-ethnographic approach to synthesise first person accounts of recovery from depression. Critical appraisal was used to contextualize the rigour of studies. The final synthesis conceptualised recovery as an non-linear process over time, encapsulating periods of relapse and gains over baseline functioning, which could be represented as growth through adversity. A number of interlinked processes worked in concert to support recovery: “recovery toolkit”, “agency”, “being-in-relationships”, “insight”, “stigma”, “resilience” and “hope”. Findings converged with the existing literature on recovery, suggesting that recovery from depression is governed by similar processes to other mental health conditions. The review highlighted the limitations of retrospective accounts and the need for studies which could evaluate the identified gains following recovery on future well-being. The empirical study used Template Analysis to explore common process of early engagement across two psychotherapies for depression from the clients’ perspective. Sixteen transcripts representing the first two sessions for eight clients receiving either Cognitive Behavouiral Therapy or Counselling for Depression were analysed. The analysis found that, in order to engage, clients: (i) must learn about the tasks and principles of therapy; (ii) are active in adapting and managing the relationship with their therapist, and (iii) must be able to flexibly and responsively assert their own agency. The results argue for the active role of the client in managing early engagement. Future research directions and methodological shortcomings are outlined

Codesigning a Mental Health Discharge and Transitions of Care Intervention: A Modified Nominal Group Technique

Background: Discharge from acute mental health services has long been associated with mortality, risk, and related adverse outcomes for patients. Many of the interventions that currently aim to reduce adverse outcomes focus on a single group of healthcare professionals within a single healthcare setting. A recent systematic review highlights very few robust interventions that specifically aim to improve communication across services. However the importance of promoting interagency working and improving information flow between services is continually highlighted as a key priority.Methods: Using a novel codesign and experience based approach we worked with a multistakeholder group to develop possible solutions to reduce the adverse outcomes commonly associated with discharge from acute mental health services. This utilized a modified Nominal Group Technique and creative problem solving method to follow a four-stage process: Problem Identification, Solution Generation, Decision-Making, Prioritization and Implementation. Thirty-two healthcare professionals and an expert by lived experienced engaged with the process that took place over two stakeholder events.Results: Stakeholders at the first event identified and agreed upon 24 potential ideas to improve discharge from acute mental health services. These were refined at the second event to four elements of an interagency intervention: a multiagency ‘Discharge Team’ (with designated discharge coordinator), inclusive technology enabled team meetings, universal documentation and a patient generated discharge plan.Conclusion: This is the first study to codesign an interagency mental health discharge intervention based around a discharge team. We developed a model for working that places a greater focus on a patient generated discharge plan, interagency working, and information flow. A pilot of the proposed intervention is now needed to test the feasibility and effectiveness in reducing adverse outcomes

IO3- and I- Sorption from Groundwater by Layered Double Hydroxides

Several subsurface water plumes are found at the Hanford U.S. DOE site. These plumes contain many different types of hazardous components including radioactive iodate (IO3-) and iodide (I-), which may have deleterious health effects. To selectively uptake IO3- and I-, inorganic layered double hydroxide (LDH) compounds were synthesized and tested. LDHs are mixed transition metal hydroxides that contain positively charged layers that undergo anion exchange. When LDHs are submerged in the plume water, they can selectively uptake IO3- and I- and remove them from the plume. Raman spectroscopy was used to monitor the uptake of IO3- and I-. The thermodynamic properties of the LDHs were determined by differential scanning calorimetry (DSC), where a phase transition was observed in the thermogram of each LDH compound. The thermodynamic properties describe the temperature range where the LDH compounds are stable and uptake the highest concentration of IO3- and I-. Raman spectroscopy indicated which LDH compounds were the most selective for IO3-. Further experiments will be performed to determine IO­3- and I- sorption of LDH compounds in groundwater. Similar technology can then be applied to radioactive waste where interferences from other compounds are present

Provider and service-user perspectives of volunteer health-worker service provision in Ayeyarwady Region, Myanmar: a qualitative study.

OBJECTIVES: To explore perspectives and reported experiences of service users, community providers and policymakers related to volunteer health-worker services provision in a rural area of Myanmar. METHODS: A qualitative interview study was conducted in rural communities with 54 service users and 17 community providers in Ayeyarwady Region, Myanmar, and with 14 national managers and policymakers in Yangon Myanmar. Topics included reasons for seeking health services, views and experiences, and comparison with experiences of other services. Data were analysed thematically using deductive and inductive coding. RESULTS: Accessibility and affordability were important to all participants. Service users described the particular relevance of trust, familiarity and acceptability in choosing a provider. Perceived quality and effectiveness were necessary for trust to develop. Perceived value of volunteers was a cross-cutting dimension, which was interpreted differently by different participants. CONCLUSIONS: Results suggest that volunteers are appropriate and valued, and support 'availability', 'accessibility' and 'acceptability' as dimensions of health services access in this setting. However, social complexities should be considered to ensure effective service delivery. Further research into trust-building, developing quality perceptions and resulting service-user choices would be useful to inform effective policy and planning

Mnt modulates Myc-driven lymphomagenesis

The transcriptional represser Mnt is a functional antagonist of the proto-oncoprotein Myc. Both Mnt and Myc utilise Max as an obligate partner for DNA binding, and Myc/Max and Mnt/Max complexes compete for occupancy at E-box DNA sequences in promoter regions. We have previously shown in transgenic mouse models that the phenotype and kinetics of onset of haemopoietic tumours varies with the level of Myc expression. We reasoned that a decrease in the level of Mnt would increase the functional level of Myc and accelerate Myc-driven tumorigenesis. We tested the impact of reduced Mnt in three models of myc transgenic mice and in p53+/− mice. To our surprise, mnt heterozygosity actually slowed Myc-driven tumorigenesis in vavP-MYC10 and Eμ-myc mice, suggesting that Mnt facilitates Myc-driven oncogenesis. To explore the underlying cause of the delay in tumour development, we enumerated Myc-driven cell populations in healthy young vavP-MYC10 and Eμ-myc mice, expecting that the reduced rate of leukaemogenesis in mnt heterozygous mice would be reflected in a reduced number of preleukaemic cells, due to increased apoptosis or reduced proliferation or both. However, no differences were apparent. Furthermore, when mnt+/+ and mnt+/− pre-B cells from healthy young Eμ-myc mice were compared in vitro, no differences were seen in their sensitivity to apoptosis or in cell size or cell cycling. Moreover, the frequencies of apoptotic, senescent and proliferating cells were comparable in vivo in mnt+/− and mnt+/+ Eμ-myc lymphomas. Thus, although mnt heterozygosity clearly slowed lymphomagenesis in vavP-MYC10 and Eμ-myc mice, the change(s) in cellular properties responsible for this effect remain to be identified