Can Action Research Strengthen District Health Management and Improve Health Workforce Performance? A Research Protocol.

The single biggest barrier for countries in sub-Saharan Africa (SSA) to scale up the necessary health services for addressing the three health-related Millennium Development Goals and achieving Universal Health Coverage is the lack of an adequate and well-performing health workforce. This deficit needs to be addressed both by training more new health personnel and by improving the performance of the existing and future health workforce. However, efforts have mostly been focused on training new staff and less on improving the performance of the existing health workforce. The purpose of this paper is to disseminate the protocol for the PERFORM project and reflect on the key challenges encountered during the development of this methodology and how they are being overcome. The overall aim of the PERFORM project is to identify ways of strengthening district management in order to address health workforce inadequacies by improving health workforce performance in SSA. The study will take place in three districts each in Ghana, Tanzania and Uganda using an action research approach. With the support of the country research teams, the district health management teams (DHMTs) will lead on planning, implementation, observation, reflection and redefinition of the activities in the study. Taking into account the national and local human resource (HR) and health systems (HS) policies and practices already in place, 'bundles' of HR/HS strategies that are feasible within the context and affordable within the districts' budget will be developed by the DHMTs to strengthen priority areas of health workforce performance. A comparative analysis of the findings from the three districts in each country will add new knowledge on the effects of these HR/HS bundles on DHMT management and workforce performance and the impact of an action research approach on improving the effectiveness of the DHMTs in implementing these interventions. Different challenges were faced during the development of the methodology. These include the changing context in the study districts, competing with other projects and duties for the time of district managers, complexity of the study design, maintaining the anonymity and confidentiality of study participants as well as how to record the processes during the study. We also discuss how these challenges are being addressed. The dissemination of this research protocol is intended to generate interest in the PERFORM project and also stimulate discussion on the use of action research in complex studies such as this on strengthening district health management to improve health workforce performance

Decoherence in the cosmic background radiation

In this paper we analyze the possibility of detecting nontrivial quantum phenomena in observations of the temperature anisotropy of the cosmic background radiation (CBR), for example, if the Universe could be found in a coherent superposition of two states corresponding to different CBR temperatures. Such observations are sensitive to scalar primordial fluctuations but insensitive to tensor fluctuations, which are therefore converted into an environment for the former. Even for a free inflaton field minimally coupled to gravity, scalar-tensor interactions induce enough decoherence among histories of the scalar fluctuations as to render them classical under any realistic probe of their amplitudes.Comment: 15 pages, accepted to be published in Classical and Quantum Gravit

Time Dependence of Charge Transfer Processes in Diamond Studied with Positrons

We have developed a method called optical transient positron spectroscopy and apply it to study the optically induced carrier trapping and charge transfer processes in natural brown type IIa diamond. By measuring the positron lifetime with continuous and pulsed illumination, we present an estimate of the optical absorption cross section of the vacancy clusters causing the brown color. The vacancy clusters accept electrons from the valence band in the absorption process, giving rise to photoconductivity.Peer reviewe

Multi-stakeholder Perspective on Responsible Artificial Intelligence and Acceptability in Education

This study investigates the acceptability of different artificial intelligence (AI) applications in education from a multi-stakeholder perspective, including students, teachers, and parents. Acknowledging the transformative potential of AI in education, it addresses concerns related to data privacy, AI agency, transparency, explainability and the ethical deployment of AI. Through a vignette methodology, participants were presented with four scenarios where AI's agency, transparency, explainability, and privacy were manipulated. After each scenario, participants completed a survey that captured their perceptions of AI's global utility, individual usefulness, justice, confidence, risk, and intention to use each scenario's AI if available. The data collection comprising a final sample of 1198 multi-stakeholder participants was distributed through a partner institution and social media campaigns and focused on individual responses to four AI use cases. A mediation analysis of the data indicated that acceptance and trust in AI varies significantly across stakeholder groups. We found that the key mediators between high and low levels of AI's agency, transparency, and explainability, as well as the intention to use the different educational AI, included perceived global utility, justice, and confidence. The study highlights that the acceptance of AI in education is a nuanced and multifaceted issue that requires careful consideration of specific AI applications and their characteristics, in addition to the diverse stakeholders' perceptions.Comment: 28 pages, 2 appendices, 3 figures, 5 tables, original researc

The camera of the fifth H.E.S.S. telescope. Part I: System description

In July 2012, as the four ground-based gamma-ray telescopes of the H.E.S.S. (High Energy Stereoscopic System) array reached their tenth year of operation in Khomas Highlands, Namibia, a fifth telescope took its first data as part of the system. This new Cherenkov detector, comprising a 614.5 m^2 reflector with a highly pixelized camera in its focal plane, improves the sensitivity of the current array by a factor two and extends its energy domain down to a few tens of GeV. The present part I of the paper gives a detailed description of the fifth H.E.S.S. telescope's camera, presenting the details of both the hardware and the software, emphasizing the main improvements as compared to previous H.E.S.S. camera technology.Comment: 16 pages, 13 figures, accepted for publication in NIM

Genetic diversity and population structure of Angiostrongylus vasorum parasites within and between local urban foxes (Vulpes Vulpes)

Angiostrongylus vasorum is a nematode parasite of the pulmonary arteries and heart that infects domestic and wild canids. Dogs (Canis familiaris) and red foxes (Vulpes vulpes) are the most commonly affected definitive hosts. Recent studies suggest that angiostrongylosis is an emerging disease, and that red foxes may play an important role in the epidemiology of the parasite. Genetic analyses of parasites collected from dogs and foxes throughout Europe have shown that the same parasite haplotypes are commonly shared between different host species. However, the extent of genetic diversity within local A. vasorum populations and individual hosts is unknown. The objective of the present study was to assess the occurrence of genetic diversity among A. vasorum (a) recovered from different foxes within the Greater London area (a localised population, single worm per fox dataset); and (b) hosted within single foxes (multiple worms per fox dataset). During 2016, A. vasorum worms were collected from foxes culled for other purposes in London. DNA was extracted from each parasite and a partial fragment of the mitochondrial cytochrome oxidase subunit 1 (mtCOI) gene was amplified and sequenced. Sequences from the single worm dataset were compared with those published elsewhere. Combined, 19 haplotypes were described of which 15 were identified from foxes found in London, indicating that considerable genetic diversity can be detected within a local geographic area. Analysis of the multiple worm dataset identified 22 haplotypes defining worms recovered from just six foxes, emphasising the relevance of wild canines as reservoirs of genetic diversity. This is the first study to explore the genetic complexity of individual fox-hosted A. vasorum population

Muscle-only versus chimeric musculocutaneous gastrocnemius pedicled flap in complex orthoplastic reconstructions of the knee region: A retrospective study

Background: The knee region represents a challenging area of soft tissue reconstruction. Specifically, in the context of total knee arthroplasty (TKA) or following high-energy trauma with fractures and hardware fixation, soft tissue defects can expose critical structures such as joint, bone or tendon, besides the implant/plates themselves, with dramatic consequences in terms of postoperative infection and hardware contamination. Methods: A retrospective study was conducted on a prospectively maintained database from January 2016 to February 2021. Inclusion criteria involved all patients who underwent an implant-associated infection of the knee and upper third of the leg coupled with a soft tissue reconstruction (STR) using the traditional gastrocnemius muscle (GM) pedicled flap or the chimeric GM-MSAP (medial sural artery perforator) flap. Results: Thirty-eight patients were included (group A, GM flap, 22 patients; group B, chimeric GM-MSAP flap, 16 patients). No statistically significant differences were detected in terms of age, comorbidities, defect size, follow-up, and flap complications. A statistically significant difference was seen among the groups in terms of successful flap re-raise (required because of a persistent infection of the implant or in a two-stage procedure setting, including the use of a cemented spacer) in favour of the GM-MSAP group. Conclusion: The chimeric GM-MSAP, being safer to reraise if required, can be a significantly more powerful tool in those cases in which a two-stage procedure is planned or when there is a high probability for secondary intervention need, reducing the need to convert to either free flap coverage or amputation