How does district health management emerge within a complex health system? Insights for capacity strengthening in Ghana

Introduction:; District health managers (DHMs) play a pivotal role in the operation of district health systems in low-and middle income countries, including Ghana. Their capacity is determined by their competencies, but also by the organization and system in which they are embedded. The objective of this paper is to explore how district health management emerges from contextual, organizational, and individual factors in order to demonstrate that capacity strengthening efforts at district level need to transcend individual competencies to take on more systemic approaches.; Methods:; Semi-structured interviews (; n; = 21) were conducted to gain insight into aspects that affect district health management in the Eastern Region of Ghana. Interviews were conducted with DHMs (; n; = 15) from six different districts, as well as with their superiors at the regional level (; n; = 4) and peers from non-governmental organizations (; n; = 2). A thematic analysis was conducted by using an analytical approach based on systems theory.; Results:; Contextual aspects, such as priorities among elected officials, poor infrastructure and working conditions, centralized decision-making, delayed disbursement of funds and staff shortages, affect organizational processes and the way DHMs carry out their role. Enabling organizational aspects that provide DHMs with direction and a clear perception of their role, include positive team dynamics, good relations with supervisors, job descriptions, appraisals, information systems, policies and guidelines. Meanwhile, hierarchical organizational structures, agendas driven by vertical programs and limited opportunities for professional development provide DHMs with limited authority to make decisions and dampens their motivation. The DHMs ability to carry out their role effectively depends on their perception of their role and the effort they expend, in addition to their competencies. In regards to competencies, a need for more general management and leadership skills were called for by DHMs as well as by their superiors and peers.; Conclusion:; Systemic approaches are called for in order to strengthen district health management capacity. This study can provide national policy-makers, donors and researchers with a deeper understanding of factors that should be taken into consideration when developing, planning, implementing, and assessing capacity-building strategies targeted at strengthening district health management

Isolation and Structure of Germylene‐Germyliumylidenes Stabilized by N‐Heterocyclic Imines

The ditopic germanium complex FGe(NIPr)2Ge[BF4] (3[BF4]; IPr=1,3‐bis(2,6‐diisopropylphenyl)imidazolin‐2‐ylidene) is prepared by the reaction of the amino(imino)germylene (Me3Si)2NGeNIPr (1) with BF3⋅OEt2. This monocation is converted into the germylene‐germyliumylidene 3[BArF4] [ArF=3,5‐(CF3)2‐C6H3] by treatment with Na[BArF4]. The tetrafluoroborate salt 3[BF4] reacts with 2 equivalents of Me3SiOTf to give the novel complex (OTf)(GeNIPr)2[OTf] (4[OTf]), which affords 4[BArF4] and 4[Al(ORF)4] [RF=C(CF3)3] after anion exchange with Na[BArF4] or Ag[Al(ORF)4], respectively. The computational, as well as crystallographic study, reveals that 4+ has significant bis(germyliumylidene) dication character.Double charge: A monocationic four‐membered germacycle is prepared by fluorination of an amino(imino)germylene followed by fluoride abstraction. Computational analysis of the bonding situation indicates a dominant germylene‐stabilized germyliumylidene character. Its reaction with Me3SiOTf affords a unique triflate‐substituted germylene‐germyliumylidene with pronounced dicationic bis(germyliumylidene) character.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137211/1/anie201605636-sup-0001-misc_information.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137211/2/anie201605636.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137211/3/anie201605636_am.pd

How Are Professional Knowledge in Education, Attitudes towards Re-flection and the Reflective Performance of Prospective Teachers Related?

In der Debatte um das Verhältnis zwischen Theorie und Praxis wird der Reflexionskompetenz angehender Lehrpersonen eine große Bedeutung zugeschrieben, da sie vielfach als Vermittlungsinstanz zwischen theoreti-schem Wissen und praktischen Handlungserfahrungen verstanden wird (z.B. Häcker, 2017). Anknüpfend an kompetenztheoretische Rahmenmodelle (von Aufschnaiter, Fraij & Kost, 2019; Blömeke, Gustafson & Shavelson, 2015) sowie ein kognitiv-psychologisches Reflexionsverständnis (Aeppli & Lötscher, 2016; Korthagen, 2001) werden im vorliegenden Beitrag Ergebnisse einer Untersuchung zum Zusammenhang von Wissen und Reflexion berichtet. In einer Stichprobe von N=295 Lehramtsstudierenden aller Schulformen wurden das bildungswissenschaftliche Professionswissen mittels eines Wissenstests, reflexionsbezogene affektiv-motivationale Dispositionen durch Selbsteinschätzungsskalen sowie reflexionsbezogene Performanz mit Hilfe schriftlicher Situationsvignetten erfasst. Durch Korrelations- und Regressionsanalysen können signifikante, positive Zusammenhänge zwischen dem Wissen der Studierenden, der subjektiven Einschätzung der Relevanz von Reflexion im Lehramtsstudium, ihren reflexionsbezogenen Selbstwirksamkeitserwartungen sowie der reflexionsbezogenen Performanz nachgewiesen werden. In den Regressionsanalysen zeigt sich ein Effekt ausschließlich bzgl. des bildungswissenschaftlichen Wissens auf die reflexionsbezogene Performanz der Studierenden.In the debate about the relationship between theory and practice, great importance is attributed to the reflection competence of prospective teachers, as it is often understood as a mediating instance between theoretical knowledge and practical experiences (e.g. Häcker, 2017). Following competence-theoretical framework models (von Aufschnaiter, Fraij & Kost, 2019; Blömeke, Gustafson & Shavelson, 2015) as well as a cognitive-psychological understanding of reflection (Aeppli & Lötscher, 2016; Korthagen, 2001), this article reports results of a study on the connection between knowledge and reflection. In a sample of N=295 student teachers for all types of schools, the professional knowledge of educational science was assessed by means of a knowledge test, reflection-related affective-motivational dispositions by means of self-assessment scales, and reflection-related performance by means of written situation vignettes. Through correlation and regression analyses, significant, positive correlations between the students’ knowledge, their subjective assessment of the relevance of reflection in teacher training, their reflection-related self-efficacy expectations and reflection-related performance can be demonstrated. The regression analyses show an effect exclusively with regard to educational science knowledge on the reflection-related performance of the students

Practical Assessment of an Interdisciplinary Bacteriophage Delivery Pipeline for Personalized Therapy of Gram-Negative Bacterial Infections

Despite numerous advances in personalized phage therapy, smooth logistics are challenging, particularly for multidrug-resistant Gram-negative bacterial infections requiring high numbers of specific lytic phages. We conducted this study to pave the way for efficient logistics for critically ill patients by (1) closely examining and improving a current pipeline under realistic conditions, (2) offering guidelines for each step, leading to safe and high-quality phage supplies, and (3) providing a tool to evaluate the pipeline’s efficiency. Due to varying stipulations for quality and safety in different countries, we focused the pipeline on all steps up to a required phage product by a cell-free extract system. The first of three study runs included patients with respiratory bacterial infections from four intensive care units, and it revealed a cumulative time of up to 23 days. Ultimately, adjustment of specific set points of the vulnerable components of the pipeline, phage isolation, and titration increased the pipeline’s efficiency by 15% and decreased the maximum required time to 13 days. We present a site-independent practical approach to establish and optimize pipelines for personalized phage delivery, the co-organization of pipeline components between different institutions, non-binding guidelines for every step, and an efficiency check for phage laboratories