How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol

Background: Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. Methods: This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Discussion: Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in terms of how to trigger such learning and how team learning is connected with changes in organizational culture and values, and in service delivery. This realist evaluation protocol aims to contribute to this knowledge by conducting this project in a country, Spain, where great endeavours have been made towards the integration of IPV management within the health system.This study protocol has been funded through a COFAS grant (supported by COFUND action within the Marie Curie Action People, in the Seventh Framework program and the Swedish Council for Working Life and Social Research/FAS-Forskningsradet för arbetsliv och socialvetenskap) through a competitive call

Advancing the application of systems thinking in health : a realist evaluation of a capacity building programme for district managers in Tumkur, India

District health systems are constantly evolving in response to national policies, the local socio-political environment, and internal dynamics within healthcare institutions. A realist evaluation can help to make sense of these complex changes. The study compares outcomes of cases which received a capacity-building intervention for health managers, and explores how individual, institutional, and contextual factors interact and contribute to observed outcomes. Performance of health staff is determined by a variety of factors related to motivation, organisational dynamics and culture, and environmental factors including socio-economic and political forces. The paper describes the complexity of capacity-building interventions at the district level

Wartość wirtualnej bronchoskopii tomografii komputerowej w ocenie zmian nowotworowych płuc

Background: The aim of the study was to find an optimal method of bronchial tree examination using CT virtual bronchoscopy and to evaluate the method for its diagnostic accuracy in the assessment of lung malignancies. Additionally, diagnostic accuracy of the used CT system was analyzed. Material/Methods: The examination was conducted in 154 patients from the University Hospital in Cracow and the University Hospital in Leuven (Belgium). The first group of patients was examined using single detector-row HeliCat Flash CT scanner (Philips Medical Systems) in the Department of Radiology of the University Hospital in Cracow. The second group of patients was examined using 16-detectorrow Mx8000 IDT 16 CT scanner (Philips Medical System) in the University Hospital in Leuven, Belgium. Lung lesions were evaluated by their central and segmental localization in bronchial tree and the degree of bronchial tree stenosis was assessed subsequently. Results: It was shown that singleslice CT virtual bronchoscopy allows a reliable evaluation of the lesions with central localization in bronchial tree, while diagnostic accuracy of multislice CT virtual bronchoscopy is comparable with bronchofiberoscopy in the evaluation of lesions with central and segmental localization. Conclusions: As a result of the study it was concluded that type of the used CT system affected the obtained results. Multislice CT is more accurate in assessing the lesions localized in bronchial tree in considerably shorter time

The contribution of international health volunteers to the health workforce in sub-Saharan Africa

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

In search of the authentic nation: landscape and national identity in Canada and Switzerland

While the study of nationalism and national identity has flourished in the last decade, little attention has been devoted to the conditions under which natural environments acquire significance in definitions of nationhood. This article examines the identity-forming role of landscape depictions in two polyethnic nation-states: Canada and Switzerland. Two types of geographical national identity are identified. The first – what we call the ‘nationalisation of nature’– portrays zarticular landscapes as expressions of national authenticity. The second pattern – what we refer to as the ‘naturalisation of the nation’– rests upon a notion of geographical determinism that depicts specific landscapes as forces capable of determining national identity. The authors offer two reasons why the second pattern came to prevail in the cases under consideration: (1) the affinity between wild landscape and the Romantic ideal of pure, rugged nature, and (2) a divergence between the nationalist ideal of ethnic homogeneity and the polyethnic composition of the two societies under consideration

Gaia Data Release 2: Short-timescale variability processing and analysis

The Gaia DR2 sample of short-timescale variable candidates results from the investigation of the first 22 months of Gaia photometry for a subsample of sources at the Gaia faint end. For this exercise, we limited ourselves to the case of suspected rapid periodic variability. Our study combines fast-variability detection through variogram analysis, high-frequency search by means of least-squares periodograms, and empirical selection based on the investigation of specific sources seen through the Gaia eyes (e.g. known variables or visually identified objects with peculiar features in their light curves). The progressive definition and validation of this selection criterion also benefited from supplementary ground-based photometric monitoring of a few preliminary candidates, performed at the Flemish Mercator telescope (Canary Islands, Spain) between August and November 2017. We publish a list of 3,018 short-timescale variable candidates, spread throughout the sky, with a false-positive rate up to 10-20% in the Magellanic Clouds, and a more significant but justifiable contamination from longer-period variables between 19% and 50%, depending on the area of the sky. Although its completeness is limited to about 0.05%, this first sample of Gaia short-timescale variables recovers some very interesting known short-period variables, such as post-common envelope binaries or cataclysmic variables, and brings to light some fascinating, newly discovered variable sources. In the perspective of future Gaia data releases, several improvements of the short-timescale variability processing are considered, by enhancing the existing variogram and period-search algorithms or by classifying the identified candidates. Nonetheless, the encouraging outcome of our Gaia DR2 analysis demonstrates the power of this mission for such fast-variability studies, and opens great perspectives for this domain of astrophysics

Gaia Data Release 2: All-sky classification of high-amplitude pulsating stars

Out of the 1.69 billion sources in the Gaia Data Release 2 (DR2), more than half a million are published with photometric time series that exhibit light variations during 22 months of observation. An all-sky classification of common high-amplitude pulsators (Cepheids, long-period variables, Delta Scuti / SX Phoenicis, and RR Lyrae stars) is provided for stars with brightness variations greater than 0.1 mag in the G band. A semi-supervised classification approach was employed, firstly training multi-stage Random Forest classifiers with sources of known types in the literature, followed by a preliminary classification of the Gaia data and a second training phase that included a selection of the first classification results to improve the representation of some classes, before the application of the improved classifiers to the Gaia data. Dedicated validation classifiers were used to reduce the level of contamination in the published results. A relevant fraction of objects were not yet sufficiently sampled for reliable Fourier series decomposition, so classifiers were based on features derived from statistics of photometric time series in the G, BP, and RP bands, as well as from some astrometric parameters. The published classification results include 195,780 RR Lyrae stars, 150,757 long-period variables, 8550 Cepheids, and 8882 Delta Scuti / SX Phoenicis stars. All of these results represent candidates, whose completeness and contamination are described as a function of variability type and classification reliability. Results are expressed in terms of class labels and classification scores, which are available in the vari_classifier_result table of the Gaia archive

Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana)

<p>Abstract</p> <p>Background</p> <p>There is a growing consensus that linear approaches to improving the performance of health workers and health care organisations may only obtain short-term results. An alternative approach premised on the principle of human resource management described as a form of 'High commitment management', builds upon a bundles of balanced practices. This has been shown to contribute to better organisational performance. This paper illustrates an intervention and outcome of high commitment management (HiCom) at an urban hospital in Ghana. Few studies have shown how HiCom management might contribute to better performance of health services and in particular of hospitals in low and middle-income settings.</p> <p>Methods</p> <p>A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information.</p> <p>Results</p> <p>At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff.</p> <p>In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We found that these factors acted as the core mechanisms underlying the changes taking place at Ho Municipal Hospital.</p> <p>Conclusions</p> <p>This study shows how a hospital management team in Ghana succeeded in resuscitating an ailing hospital. Their high commitment management approach led to the active involvement and empowerment of staff. It also showed how a realist evaluation approach such as this, could be used in the research of the management of health care organisations to explain how management interventions may or may not work.</p

Global Health Actors Claim To Support Health System Strengthening—Is This Reality or Rhetoric?

Bruno Marchal and colleagues argue that most current strategies aimed at health systems strengthening remain selectively targeted at specific diseases