Implementing health research through academic and clinical partnerships : a realistic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC)

Background: The English National Health Service has made a major investment in nine partnerships between higher education institutions and local health services called Collaborations for Leadership in Applied Health Research and Care (CLAHRC). They have been funded to increase capacity and capability to produce and implement research through sustained interactions between academics and health services. CLAHRCs provide a natural ‘test bed’ for exploring questions about research implementation within a partnership model of delivery. This protocol describes an externally funded evaluation that focuses on implementation mechanisms and processes within three CLAHRCs. It seeks to uncover what works, for whom, how, and in what circumstances. Design and methods: This study is a longitudinal three-phase, multi-method realistic evaluation, which deliberately aims to explore the boundaries around knowledge use in context. The evaluation funder wishes to see it conducted for the process of learning, not for judging performance. The study is underpinned by a conceptual framework that combines the Promoting Action on Research Implementation in Health Services and Knowledge to Action frameworks to reflect the complexities of implementation. Three participating CLARHCS will provide indepth comparative case studies of research implementation using multiple data collection methods including interviews, observation, documents, and publicly available data to test and refine hypotheses over four rounds of data collection. We will test the wider applicability of emerging findings with a wider community using an interpretative forum. Discussion: The idea that collaboration between academics and services might lead to more applicable health research that is actually used in practice is theoretically and intuitively appealing; however the evidence for it is limited. Our evaluation is designed to capture the processes and impacts of collaborative approaches for implementing research, and therefore should contribute to the evidence base about an increasingly popular (e.g., Mode two, integrated knowledge transfer, interactive research), but poorly understood approach to knowledge translation. Additionally we hope to develop approaches for evaluating implementation processes and impacts particularly with respect to integrated stakeholder involvement

Loans and Leaving: Migration and the Expansion of Microcredit in Cambodia

Over the last decade, the expansion of microfinance institutions (MFIs) has dramatically shifted the availability of credit across the developing world. This recent development provides an opportunity to examine the relationship between household labor migration and access to and use of formal credit. Both theories of migration and the expectations of formal credit providers have suggested that labor migration and credit are substitute solutions to the demand for capital in the developing world, with the implication that greater access to formal financial services may stem migration out of rural places. Using household survey data from Cambodia, an MFI-saturated country, we find that households using formal credit and households with greater access to formal credit are more likely to have labor migrants than households without access. This association persists across size of loan, purpose of loan, remittances behavior, and for domestic migrations. These findings complicate our understanding of the relationship between credit and migration, and call for a greater recognition of the importance of context in framing migration behavior

Una sólida alianza para el desarrollo: Centroamérica y el BID desde 1990

Los albores del decenio de 1990 fueron un período de gran trascendencia para los países centroamericanos, que emergían de la llamada "década perdida" de los años ochenta. Fue una época en que los nuevos gobiernos elegidos democráticamente pudieron por fin prestar atención a las múltiples y complejas tareas de lograr la estabilidad macroeconómica y liberalizar sus economías. Este libro se refiere al papel protagónico que desempeñó el BID durante ese tramo de la historia moderna de Centroamérica, durante el cual se redefinió el papel del Estado, se desarrollaron nuevas relaciones con el sector privado y la sociedad civil y se impulsaron programas sociales innovadores destinados a combatir los alarmantes niveles de pobreza. Este libro abarca los siguientes temas clave al renovado proceso de desarrollo de la región: reforma de los sectores de infraestructura básica, desarrollo de los mercados financieros, innovaciones en los sectores sociales, avances significativos en la gestión del medio ambiente, fortalecimiento de la democracia, integración regional, desarrollo de la microempresa, gestión de riesgos de desastres naturales, y la coordinación de donantes a través de la conducción de los grupos consultivos para Centroamérica.

DETECTION OF HTLV-I ANTIBODIES AND DNA IN BLOOD SAMPLE OF A PATIENT WITH MYELOPATHY IN NIGERIA

We describe a case of human T-lymphotropic virus type I associated myelopathy in a 50-year old woman in Nigeria. The patient presented with progressive loss of tone to the two lower limbs and later inability to walk. The HTLV-I antibody presence in the plasma collected from the patient was repeatedly detected by enzyme immunoassays (Abbott HTLV-I EIA and Coulter SELECT-HTLV I/II) and confirmed by Western blot technique. In addition, HTLV-I DNA was amplified from the genomic DNA isolated from the peripheral blood mononuclear cells of the patient by the polymerase chain reaction technique. This finding is significant being the first report of association of HTLV-I with myelopathy in Nigeria.<br>Descrevemos um caso de infecção por HTLV-I associado a mielopatia, em mulher de 50 anos, na Nigéria. A paciente apresentou fraqueza progressiva dos membros inferiores e posteriormente incapacidade para andar. A presença de anticorpo HTLV-I no plasma coletado da paciente foi repetidamente detectada pelos ensaios imunoenzimáticos (Abbott HTLV-I EIA e Coulter SELECT-HTLV I/II) e confirmada pela técnica de Western Blot. Adicionalmente amplificou-se o DNA do HTLV-I a partir do DNA genômico isolado das células mononucleares do sangue periférico da paciente através da técnica PCR. Este achado é significativo sendo o primeiro relato de associação de HTLV-I com mielopatia, na Nigéria

Biomass and Stand Characteristics of a Highly Productive Mixed Douglas-Fir and Western Hemlock Plantation in Coastal Washington

Aboveground biomass predictive equations were developed for a highly productive 47-year-old mixed Douglas-fir and western hemlock stand in southwest Washington State to characterize the preharvest stand attributes for the Fall River Long-Term Site Productivity Study. The equations were developed using detailed biomass data taken from 31 Douglas-fir and 11 western hemlock trees within the original stand. The stand had an average of 615 live trees per hectare, with an average dbh of 35.6 cm (39.1 cm for Douglas-fir and 33.3 cm for western hemlock) and an average total tree height of 31.6 m (32.8 m for Douglas-fir and 30.2 m for western hemlock). Equations developed were of the form In Y = b(1) + b(2) In dbh, where Y = biomass in kg, dbh = diameter in cm at 1.3 m height, b(1) = intercept, and b(2) = slope of equation. Each tree part was estimated separately and also combined into total aboveground biomass. The total aboveground biomass estimation equations were In Y = -0.9950 + 2.0765 In dbh for Douglas-fir, and In Y = -1.6612 + 2.2321 In dbh for western hemlock. The estimate of the aboveground live-free biomass was of 395 Mg ha(-1) (235 Mg ha(-1) for Douglas-fir and 160 Mg ha(-1) for western hemlock), with 9.5, 29.3, 12.9, 308, and 32.7 Mg ha(-1) in the foliage, live branches, dead branches, stem wood, and stem hark, respectively. When compared with biomass estimates from six other studies, ranging in age from 22 to 110 years and from 96.3 to 636 Mg ha(-1), the biomass of the Fall River site was relatively high for its age, indicating very high productivity