How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature

Background Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs. Methods We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized. Results Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes. Conclusions Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance

Element release and reaction-induced porosity alteration during shale-hydraulic fracturing fluid interactions

The use of hydraulic fracturing techniques to extract oil and gas from low permeability shale reservoirs has increased significantly in recent years. During hydraulic fracturing, large volumes of water, often acidic and oxic, are injected into shale formations. This drives fluid-rock interaction that can release metal contaminants (e.g., U, Pb) and alter the permeability of the rock, impacting the transport and recovery of water, hydrocarbons, and contaminants. To identify the key geochemical processes that occur upon exposure of shales to hydraulic fracturing fluid, we investigated the chemical interaction of hydraulic fracturing fluids with a variety of shales of different mineralogical texture and composition. Batch reactor experiments revealed that the dissolution of both pyrite and carbonate minerals occurred rapidly, releasing metal contaminants and generating porosity. Oxidation of pyrite and aqueous Fe drove precipitation of Fe(III)-(oxy)hydroxides that attenuated the release of these contaminants via co-precipitation and/or adsorption. The precipitation of these (oxy)hydroxides appeared to limit the extent of pyrite reaction. Enhanced removal of metals and contaminants in reactors with higher fluid pH was inferred to reflect increased Fe-(oxy)hydroxide precipitation associated with more rapid aqueous Fe(II) oxidation. The precipitation of both Al- and Fe-bearing phases revealed the potential for the occlusion of pores and fracture apertures, whereas the selective dissolution of calcite generated porosity. These pore-scale alterations of shale texture and the cycling of contaminants indicate that chemical interactions between shales and hydraulic fracturing fluids may exert an important control on the efficiency of hydraulic fracturing operations and the quality of water recovered at the surface

Adolescents with symptomatic laminolysis: report of two cases

Retroisthmic cleft refers to a cleft in the lamina and is rarely reported. It was first described by Brocher, and later Wick et al. proposed the term “laminolysis” to describe the retroisthmic cleft by analogy with the nomenclature of the applied stress fracture of the pars interarticularis (spondylolysis) and the pedicle (pediculolysis). In this paper, we describe two adolescent sports players with symptomatic lumbar laminolysis. Both improved significantly after adequate conservative treatment. Knowledge of laminolysis in adolescent patients with low back pain is necessary to avoid overlooking it and late diagnosis. For correct diagnosis, multidetector three-dimensional computed tomography (CT) is suggested. In addition, magnetic resonance imaging (MRI) also allows detection of inflammation in the defects

The role of quantitative cross-case analysis in understanding tropical smallholder farmers’ adaptive capacity to climate shocks

Climate shocks are predicted to increase in magnitude and frequency as the climate changes, notably impacting poor and vulnerable communities across the Tropics. The urgency to better understand and improve communities' resilience is reflected in international agreements such as the Paris Agreement and the multiplication of adaptation research and action programs. In turn, the need for collecting and communicating evidence on the climate resilience of communities has increasingly drawn questions concerning how to assess resilience. While empirical case studies are often used to delve into the context-specific nature of resilience, synthesizing results is essential to produce generalizable findings at the scale at which policies are designed. Yet datasets, methods and modalities that enable cross-case analyses that draw from individual local studies are still rare in climate resilience literature. We use empirical case studies on the impacts of El Niño on smallholder households from five countries to test the application of quantitative data aggregation for policy recommendation. We standardized data into an aggregated dataset to explore how key demographic factors affected the impact of climate shocks, modeled as crop loss. We find that while cross-study results partially align with the findings from the individual projects and with theory, several challenges associated with quantitative aggregation remain when examining complex, contextual and multi-dimensional concepts such as resilience. We conclude that future exercises synthesizing cross-site empirical evidence in climate resilience could accelerate research to policy impact by using mixed methods, focusing on specific landscapes or regional scales, and facilitating research through the use of shared frameworks and learning exercises

Hidden Cues in Random Line Stereograms

Successful fusion of random-line stereograms with breaks in the vernier acuity range has been interpreted to suggest that the interpolation process underlying hyperacuity is parallel and preliminary to stereomatching. In this paper (a) we demonstrate with computer experiments that vernier cues are not needed to solve the stereomatching problem posed by these stereograms and (b) we provide psychophysical evidence that human stereopsis probably does not use vernier cues alone to achieve fusion of these random-line stereograms.MIT Artificial Intelligence Laborator

Sound-contingent visual motion aftereffect

<p>Abstract</p> <p>Background</p> <p>After a prolonged exposure to a paired presentation of different types of signals (e.g., color and motion), one of the signals (color) becomes a driver for the other signal (motion). This phenomenon, which is known as contingent motion aftereffect, indicates that the brain can establish new neural representations even in the adult's brain. However, contingent motion aftereffect has been reported only in visual or auditory domain. Here, we demonstrate that a visual motion aftereffect can be contingent on a specific sound.</p> <p>Results</p> <p>Dynamic random dots moving in an alternating right or left direction were presented to the participants. Each direction of motion was accompanied by an auditory tone of a unique and specific frequency. After a 3-minutes exposure, the tones began to exert marked influence on the visual motion perception, and the percentage of dots required to trigger motion perception systematically changed depending on the tones. Furthermore, this effect lasted for at least 2 days.</p> <p>Conclusions</p> <p>These results indicate that a new neural representation can be rapidly established between auditory and visual modalities.</p

Relaxor ferroelectricity and colossal magnetocapacitive coupling in ferromagnetic CdCr2S4

Multiferroic materials, which reveal magnetic and electric order, are in the focus of recent solid state research. Especially the simultaneous occurrence of ferroelectricity and ferromagnetism, combined with an intimate coupling of magnetization and polarization via magneto-capacitive effects, could pave the way for a new generation of electronic devices. Here we present measurements on a simple cubic spinel with unusual properties: It shows ferromagnetic order and simultaneously relaxor ferroelectricity, i.e. a ferroelectric cluster state, reached by a smeared-out phase transition, both with sizable ordering temperatures and moments. Close to the ferromagnetic ordering temperature the magneto-capacitive coupling, characterized by a variation of the dielectric constant in an external magnetic field, reaches colossal values of nearly 500%. We attribute the relaxor properties to geometric frustration, which is well known for magnetic moments, but here is found to impede long-range order of the structural degrees of freedom.Comment: 4 pages, 3 figure

Mapping of hormones and cortisol responses in patients after Lyme neuroborreliosis

<p>Abstract</p> <p>Background</p> <p>Persistent symptoms after treatment for neuroborreliosis are common for reasons mainly unknown. These symptoms are often unspecific and could be caused by dysfunctions in endocrine systems, an issue that has not been previously addressed systematically. We therefore mapped hormone levels in patients with previous confirmed Lyme neuroborreliosis of different outcomes and compared them with a healthy control group.</p> <p>Methods</p> <p>Twenty patients of a retrospective cohort of patients treated for definite Lyme neuroborreliosis were recruited 2.3 to 3.7 years (median 2.7) after diagnosis, together with 23 healthy controls. Lyme neuroborreliosis patients were stratified into two groups according to a symptom/sign score. All participants underwent anthropometric and physiological investigation as well as an extensive biochemical endocrine investigation including a short high-dose adrenocorticotropic hormone stimulation (Synacthen^®) test. In addition to hormonal status, we also examined electrolytes, 25-hydroxy-vitamin D and interleukin-6.</p> <p>Results</p> <p>Eight patients (40%) had pronounced symptoms 2-3 years after treatment. This group had a higher cortisol response to synacthen as compared with both controls and the Lyme neuroborreliosis patients without remaining symptoms (p < 0.001 for both comparisons). No other significant differences in the various baseline biochemical parameters, anthropometric or physiological data could be detected across groups.</p> <p>Conclusions</p> <p>Apart from a positive association between the occurrence of long-lasting complaints after Lyme neuroborreliosis and cortisol response to synacthen, no corticotropic insufficiency or other serious hormonal dysfunction was found to be associated with remaining symptoms after treatment for Lyme neuroborreliosis.</p

Sulforaphane Causes Epigenetic Repression of hTERT Expression in Human Breast Cancer Cell Lines

Sulforaphane (SFN), an isothiocyanate found in cruciferous vegetables, is a common dietary component that has histone deacetylase inhibition activity and exciting potential in cancer prevention. The mechanisms by which SFN imparts its chemopreventive properties are of considerable interest and little is known of its preventive potential for breast cancer. expression facilitated the induction of cellular apoptosis in human breast cancer cells.Collectively, our results provide novel insights into SFN-mediated epigenetic down-regulation of telomerase in breast cancer prevention and may open new avenues for approaches to SFN-mediated cancer prevention