Building leadership capacity and future leaders in operational research in low-income countries: why and how?

Very limited operational research (OR) emerges from programme settings in low-income countries where the greatest burden of disease lies. The price paid for this void includes a lack of understanding of how health systems are actually functioning, not knowing what works and what does not, and an inability to propose adapted and innovative solutions to programme problems. We use the National Tuberculosis Control Programme as an example to advocate for strong programme-level leadership to steer OR and build viable relationships between programme managers, researchers and policy makers. We highlight the need to create a stimulating environment for conducting OR and identify some of the main practical challenges and enabling factors at programme level. We focus on the important role of an OR focal point within programmes and practical approaches to training that can deliver timely and quantifiable outputs. Finally, we emphasise the need to measure successful OR leadership development at programme level and we propose parameters by which this can be assessed. This paper 1) provides reasons why programmes should take the lead in coordinating and directing OR, 2) identifies the practical challenges and enabling factors for implementing, managing and sustaining OR and 3) proposes parameters for measuring successful leadership capacity development in OR

Salivary and gingival crevicular fluid histatin in periodontal health and disease

Objectives: Histatin, with its anti bacterial, anti protease, and wound closure stimulating property might influence the pathogenesis of periodontal disease. This study assessed the presence of histatin in gingival crevicular fluid (GCF); the levels of salivary and GCF histatin in periodontal disease. Material and methods: It was a cross sectional study that included systemically healthy forty five subjects (22 males and 23 females) between the age group of 20 to 45 years. Based on Gingival Index (Loe and Silness ,1963) and Russell's Periodontal Index they were grouped as 15 healthy (Group 1), 15 gingivitis (Group 2), and 15 periodontitis (Group 3) subjects. Whole pooled unstimulated saliva was collected by asking the patient to spit in a sterile container and GCF samples were collected using a micropipette from all the subjects. Histatin levels were assessed using Enzyme Linked Immunosorbent Assay (ELISA). The intergroup comparison was done by ANOVA and Mann Whitney U Test was done for pair wise comparison. Results: The results of this study show that histatin is present in saliva and gingival crevicular fluid. When the salivary histatin levels were compared it was found that the levels of histatin increase from health to periodontitis but the levels of histatin in the gingival crevicular fluid and saliva had no correlation with severity of periodontal disease as there was no statistically significant difference between the three groups. Conclusions: It can be concluded that histatin cannot be used as a potential marker of periodontal disease

Craft and gear in mangroves - Responsible fishing

How to reconcile livelihood concerns of the marginalized people who inhabit the mangrove areas with that of resource conservation. It is indeed the Achilles’ heel of any mangrove management programme especially when designed in the context of a paradigm of Responsible fisheries as being advocated the world over

Triceps Activation Amplitudes during Functional Activities

Objective: To investigate the muscular activation amplitudes of three regions of triceps musculature during functional activities. We hypothesized that the medial and lateral triceps would be greatest in the terminal 30° arc of extension activities. Design: Cross sectional. Setting: Musculoskeletal Clinical Laboratory. Participants: 20 healthy subjects recruited from a sample of convenience. Intervention: Fine wire electromyograhical (EMG) electrodes were placed into the medial, central, and lateral triceps to measure muscular activation amplitude and two dimensional electrogoniometric kinematic activity was recorded during functional activities associated with activities of daily living. Main Outcome Measure(s): Root mean squared amplitudes of triceps muscles normalized to maximal voluntary isometric contractions that are sub-divided into 30° arcs of motion. Results: The medial triceps generated significantly more EMG activity during the terminal 30° arc of supine extension (54±11%MVIC, p\u3c.05) and during the pushing activity (29±7% MVIC, p\u3c.01). The lateral triceps remained relatively constant throughout all arcs, while the central triceps consistently generated the lowest EMG activation level across all functional tasks. Conclusion: The hypothesis is partially supported as the medial triceps generated more activity in two of the three tasks during the terminal 30° of extension. The lateral portion is activated consistently throughout the extension motion and acts as a dynamic stabilizer during extension activities. These results indicate that the constant activity of the lateral insertion of the triceps, in conjunction with the terminal extension activity of the medial insertion, play a primary role in terminal elbow extension, especially in anti-gravity and load bearing activities. This new data has implications for surgical approaches to the elbow, management of elbow injuries, and rehabilitation of this joint

Should Sputum Smear Examination Be Carried Out at the End of the Intensive Phase and End of Treatment in Sputum Smear Negative Pulmonary TB Patients?

The Indian guidelines on following up sputum smear-negative Pulmonary tuberculosis (PTB) patients differ from the current World Health Organization (WHO) guidelines in that the former recommends two follow up sputum examinations (once at the end of intensive phase and the other at the end of treatment) while the latter recommends only one follow up sputum smear microscopy examination, which is done at the end of the intensive phase. This study was conducted to examine if there was any added value in performing an additional sputum smear examination at the end of treatment within the context of a national TB program