A New Endemic Focus of Chagas Disease in the Northern Region of Veraguas Province, Western Half Panama, Central America

Background: Chagas disease was originally reported in Panama in 1931. Currently, the best knowledge of this zoonosis is restricted to studies done in historically endemic regions. However, little is known about the distribution and epidemiology of Chagas disease in other rural areas of the country. Methods and Findings: A cross-sectional descriptive study was carried out between May 2005 – July 2008 in four rural communities of the Santa Fe District, Veraguas Province. The study included an entomologic search to collect triatomines, bloodmeal type identification and infection rate with trypanosomes in collected vectors using a dot- blot and PCR analysis, genotyping of circulating Trypanosoma cruzi (mini-exon gene PCR analysis) and the detection of chagasic antibodies among inhabitants. The vector Rhodnius pallescens was more frequently found in La Culaca and El Pantano communities (788 specimens), where it was a sporadic household visitor. These triatomines presented darker coloration and larger sizescompared with typical specimens collected in Central Panama. Triatoma dimidiata was more common in Sabaneta de El Macho (162 specimens). In one small sub-region (El Macho), 60 % of the houses were colonized by this vector. Of the examined R. pallescens, 54.7.0 % (88/161) had fed on Didelphis marsupialis, and 24.6 % (34/138) of T. dimidiata specimens collected inside houses were positive for human blood. R. pallescens presented an infection index with T. cruzi of 17.7 % (24/ 136), with T. rangeli of 12.5 % (17/136) and 50.7 % (69/136) were mixed infections. In 117 T. dimidiata domestic specimens th

Onboarding: How Newcomers Integrate into an Agile Project Team

Although a stable team is deemed optimal for agile project success, new team members need to join ongoing agile projects. New- comers must rapidly assimilate into the organisational and project envi- ronment while learning how to contribute effectively to the project and integrate into the team without seriously interrupting project progress. This paper addresses how newcomers integrate into an established agile project team and the challenges newcomers and the team face during this process. This paper is a single case study of a co-located agile project team in a large IT department who regularly onboard inexperienced new- comers. We found a mixture of traditional onboarding practices and spe- cific agile practices contribute to the onboarding process. Onboarding challenges include empowerment and mindset change, accommodating part-timers, conveying agile principles, and adjusting to changes in team composition

The excess mortality risk of diabetes associated with functional decline in older adults: Results from a 7-year follow-up of a nationwide cohort in Taiwan

<p>Abstract</p> <p>Background</p> <p>Diabetes is associated with an increased risk of functional decline in older adults. Few studies have investigated the contribution of functional decline to excess mortality risk in older people with diabetes. The aim of this study was to examine how diabetes in combination with different levels of functional decline affects 7-year mortality in older adults.</p> <p>Methods</p> <p>We analyzed data from a nationally representative sample of people aged 65 years and over, participating in the 2001 National Health Interview Survey in Taiwan. A total of 1873 participants were followed through 2002-2008, of whom 286 (15.3%) had a history of diabetes confirmed by a medical professional. Participants were divided into three functional status groups: (1) high functioning-no limitations involving activities of daily living (ADLs), instrumental activities of daily living (IADLs), or physical functioning; (2) low functioning-limitations in one or more ADLs; (3) middle functioning-all participants in between groups 1 and 2.</p> <p>Results</p> <p>The crude mortality rate was 52.7 per 1,000 person-years in those with diabetes and 34.1 per 1,000 person-years in those without diabetes. After adjustment for other factors, diabetes alone was not associated with an increased mortality risk in those with high functioning. However, diabetes alone had a hazard ratio (HR) for mortality of 1.90 (95%CI = [1.02-3.53]) in those with middle functioning and 3.67 (95%CI = [1.55-8.69]) in those with low functioning. The presence of diabetes and one or more other chronic conditions was associated with a HR for mortality of 2.46 (95%CI = [1.61-3.77]) in those with middle functioning and 4.03 (95%CI = [2.31-7.03]) in those with low functioning.</p> <p>Conclusions</p> <p>Our results indicate that diabetes is not associated with increased mortality in those with high functioning. There was a gradient effect of functional decline on mortality in individuals with diabetes. Additionally, among participants with other chronic conditions, functional decline was associated with a greater burden of mortality in older adults with diabetes. These findings highlight the critical importance of the prevention of cardiovascular disease morbidity and the maintenance of functional abilities in order to reduce mortality risk in older adults with diabetes.</p

Risk factors associated with Trypanosoma cruziexposure in domestic dogs from a rural community in Panama

Chagas disease, caused by Trypanosoma cruzi infection, is a zoonosis of humans, wild and domestic mammals,including dogs. In Panama, the main T. cruzi vector is Rhodnius pallescens, a triatomine bug whose main naturalhabitat is the royal palm, Attalea butyracea. In this paper, we present results from three T. cruzi serological tests(immunochromatographic dipstick, indirect immunofluorescence and ELISA) performed in 51 dogs from 24 housesin Trinidad de Las Minas, western Panama. We found that nine dogs were seropositive (17.6% prevalence). Dogswere 1.6 times more likely to become T. cruzi seropositive with each year of age and 11.6 times if royal palms wherepresent in the peridomiciliary area of the dog’s household or its two nearest neighbours. Mouse-baited-adhesivetraps were employed to evaluate 12 peridomestic royal palms. All palms were found infested with R. pallescens withan average of 25.50 triatomines captured per palm. Of 35 adult bugs analysed, 88.6% showed protozoa flagellates intheir intestinal contents. In addition, dogs were five times more likely to be infected by the presence of an additionaldomestic animal species in the dog’s peridomiciliary environment. Our results suggest that interventions focused onroyal palms might reduce the exposure to T. cruzi infection

Managing formalization to increase global team effectiveness and meaningfulness of work in multinational organizations

Global teams may help to integrate across locations, and yet, with formalized rules and procedures, responsiveness to those locations’ effectiveness, and the team members’ experiences of work as meaningful may suffer. We employ a mixed-methods approach to understand how the level and content of formalization can be managed to resolve these tensions in multinationals. In a sample of global teams from a large mining and resources organization operating across 44 countries, interviews, observations, and a quantitative 2-wave survey revealed a great deal of variability between teams in how formalization processes were enacted. Only those formalization processes that promoted knowledge sharing were instrumental in improving team effectiveness. Implementing rules and procedures in the set-up of the teams and projects, rather than during interactions, and utilizing protocols to help establish the global team as a source of identity increased this knowledge sharing. Finally, we found members’ personal need for structure moderated the effect of team formalization on how meaningful individuals found their work within the team. These findings have significant implications for theory and practice in multinational organizations

Cutaneous Leishmaniasis and Sand Fly Fluctuations Are Associated with El Nino in Panama

BackgroundCutaneous Leishmaniasis (CL) is a neglected tropical vector-borne disease. Sand fly vectors (SF) and Leishmania spp parasites are sensitive to changes in weather conditions, rendering disease transmission susceptible to changes in local and global scale climatic patterns. Nevertheless, it is unclear how SF abundance is impacted by El Nino Southern Oscillation (ENSO) and how these changes might relate to changes in CL transmission.Methodology and FindingsWe studied association patterns between monthly time series, from January 2000 to December 2010, of: CL cases, rainfall and temperature from Panama, and an ENSO index. We employed autoregressive models and cross wavelet coherence, to quantify the seasonal and interannual impact of local climate and ENSO on CL dynamics. We employed Poisson Rate Generalized Linear Mixed Models to study SF abundance patterns across ENSO phases, seasons and eco-epidemiological settings, employing records from 640 night-trap sampling collections spanning 2000?2011. We found that ENSO, rainfall and temperature were associated with CL cycles at interannual scales, while seasonal patterns were mainly associated with rainfall and temperature. Sand fly (SF) vector abundance, on average, decreased during the hot and cold ENSO phases, when compared with the normal ENSO phase, yet variability in vector abundance was largest during the cold ENSO phase. Our results showed a three month lagged association between SF vector abundance and CL cases.ConclusionAssociation patterns of CL with ENSO and local climatic factors in Panama indicate that interannual CL cycles might be driven by ENSO, while the CL seasonality was mainly associated with temperature and rainfall variability. CL cases and SF abundance were associated in a fashion suggesting that sudden extraordinary changes in vector abundance might increase the potential for CL epidemic outbreaks, given that CL epidemics occur during the cold ENSO phase, a time when SF abundance shows its highest fluctuations