Exploring the Lived Experiences of Daughters/ Daughters-in-Law Providing Primary Informal Care to Their Mothers/ Mothers-in-Law with Dementia

Abstract Objective As the senior population in Canada rises, more middle aged residents of Canada will find themselves taking on a caregiving role, often times for a parent with dementia. This research examines the lived experiences of daughters/daughters-in-law providing primary informal care to their mothers/mothers-in-law with dementia in order to understand the motivations, effects, and transitions within caregiving relationships. Methods Phenomenology was the theoretical orientation used to guide this research and captured individuals’ lived experiences. Background questionnaires were administered initially, followed by one-on-one semi-structured interviews which were transcribed verbatim upon completion for data analysis. Field notes, member checks, and triangulation were used to further enhance the credibility of the study. Results From the analysis, four themes emerged: (1) “Master of none.”: The many roles of informal caregivers; (2) The face of dementia; (3) “What a life!?”; and (4)“Every so often you see a little bit of light.”: The silver linings. All of the women expressed experiencing a multitude of both positive and negative effects as a result of their caregiving experiences. Conclusions Informal caregivers play an integral role in the Canadian health care system. This study provides a glimpse into the hectic lives of these informal female filial dementia caregivers. Their stories can provide strength and hope for individuals who have provided care for family members with dementia in the past, in the present, or will do so in the future

Where teachers are few: documenting available faculty in five Tanzanian medical schools.

BACKGROUND:Faced with one of the lowest physician-to-population ratios in the world, the Government of Tanzania is urging its medical schools to train more physicians. The annual number of medical students admitted across the country rose from 55 in the 1990s to 1,680 approved places for the 2015/16 academic year. These escalating numbers strain existing faculty. OBJECTIVE:To describe the availability of faculty in medical schools in Tanzania. DESIGN:We identified faculty lists published on the Internet by five Tanzanian medical schools for the 2011/12 academic year and analyzed the appointment status, rank, discipline, and qualifications of faculty members. RESULTS:The five schools reported 366 appointed faculty members (excluding visiting, part-time, or honorary appointments) for an estimated total enrolled student capacity of 3,275. Thirty-eight percent of these faculty were senior lecturers or higher. Twenty-seven percent of the appointments were in basic science, 51% in clinical science, and 21% in public health departments. The most populated disciplines (more than 20 faculty members across the five institutions) were biochemistry and molecular biology, medicine, obstetrics and gynecology, pediatrics, and surgery; the least populated disciplines (less than 10 faculty members) were anesthesiology, behavioral sciences, dermatology, dental surgery, emergency medicine, hematology, ophthalmology, orthopedics, otorhinolaryngology, oncology and radiology, psychiatry. These figures are only indicative of faculty numbers because of differences in the way the schools published their faculty lists. CONCLUSIONS:Universities are not recruiting faculty at the same rate that they are admitting students, and there is an imbalance in the distribution of faculty across disciplines. Although there are differences among the universities, all are struggling to recruit and retain staff. If Tanzanian universities, the government, donors, and international partners commit resources to develop, recruit, and retain new faculty, Tanzania could build faculty numbers to permit a quality educational experience for its doctors of tomorrow

Modeling solutions to Tanzania's physician workforce challenge.

BACKGROUND:There is a great need for physicians in Tanzania. In 2012, there were approximately 0.31 physicians per 10,000 individuals nationwide, with a lower ratio in the rural areas, where the majority of the population resides. In response, universities across Tanzania have greatly increased the enrollment of medical students. Yet evidence suggests high attrition of medical graduates to other professions and emigration from rural areas where they are most needed. OBJECTIVE:To estimate the future number of physicians practicing in Tanzania and the potential impact of interventions to improve retention, we built a model that tracks medical students from enrollment through clinical practice, from 1990 to 2025. DESIGN:We designed a Markov process with 92 potential states capturing the movement of 25,000 medical students and physicians from medical training through employment. Work possibilities included clinical practice (divided into rural or urban, public or private), non-clinical work, and emigration. We populated and calibrated the model using a national 2005/2006 physician mapping survey, as well as graduation records, graduate tracking surveys, and other available data. RESULTS:The model projects massive losses to clinical practice between 2016 and 2025, especially in rural areas. Approximately 56% of all medical school students enrolled between 2011 and 2020 will not be practicing medicine in Tanzania in 2025. Even with these losses, the model forecasts an increase in the physician-to-population ratio to 1.4 per 10,000 by 2025. Increasing the absorption of recent graduates into the public sector and/or developing a rural training track would ameliorate physician attrition in the most underserved areas. CONCLUSIONS:Tanzania is making significant investments in the training of physicians. Without linking these doctors to employment and ensuring their retention, the majority of this investment in medical education will be jeopardized

A pre-post evaluation of an online career planning module on university students’ career adaptability

Indecisiveness and negative thinking regarding career pathways can hinder university students’ career planning, motivation, and mental health. Students intending to enter the workforce after graduation therefore need to develop skills related to career adaptability (i.e. career planning, decision-making, problem solving/confidence and exploration), particularly since career planning and construction is linked to gaining employment. This study aimed to test the effectiveness of an online career planning module on students’ career adaptability.  The career-focussed online module, based on the constructs of Savickas’ (2005) theory of career construction, and tailored to students’ skills and interests, was developed and embedded into the University curriculum of a second-year exercise and public health-related unit. In 2018, 80 students completed the online module, along with pre- and post-intervention questionnaires assessing career adaptability elements including career planning, decision making, problem solving/confidence, and exploration. Dependent t-tests were conducted to assess differences in these measures pre- and post-intervention. Post-intervention, significant increases in career-planning strategies used (t(69)=5.45, p<0.001), career planning concern (t(69)=3.73, p<0.001), decision making (i.e. career path identification) (t(70)=3.86, p<0.001), decision making confidence (t(65)=2.69, p<0.01), and problem solving/confidence (t(65) = 2.16, p=0.03) were observed. Further, 80% of participants identified jobs at post-intervention not previously identified pre-intervention (exploration) and 71% of participants perceived improvements in confidence regarding job ideas/making career choices.  Findings from this research indicated that completing a brief online career education module, tailored to an individual’s skills and interests, improved all dimensions of the participating students’ career adaptability. Further research utilising longer-term follow-up and randomised controlled trial designs are required to confirm the reliability and transferability of the findings

External review : IDRC Governance for Equity in Health Systems Program

By 2011, the IDRC’s Governance for Equity in Health Systems (GEHS) and other stakeholders had made considerable progress in establishing the legitimacy of the field, developing methodology and building a critical mass of international health systems researchers. The 2011-2016 Prospectus identified four outcomes towards the goal of improved health in lower- and middle-income countries (LMICs) through strengthened equitable health systems. This evaluation provides analysis of programming investments, program adaptability, quality of research and the relevance and significance of program outputs. GEHS’s achievements are above expectations; there is no similar research funding program that has accomplished as much given the time elapsed and available resources

A novel framework employing deep multi-attention channels network for the autonomous detection of metastasizing cells through fluorescence microscopy

We developed a transparent computational large-scale imaging-based framework that can distinguish between normal and metastasizing human cells. The method relies on fluorescence microscopy images showing the spatial organization of actin and vimentin filaments in normal and metastasizing single cells, using a combination of multi-attention channels network and global explainable techniques. We test a classification between normal cells (Bj primary fibroblast), and their isogenically matched, transformed and invasive counterpart (BjTertSV40TRasV12). Manual annotation is not trivial to automate due to the intricacy of the biologically relevant features. In this research, we utilized established deep learning networks and our new multi-attention channel architecture. To increase the interpretability of the network - crucial for this application area - we developed an interpretable global explainable approach correlating the weighted geometric mean of the total cell images and their local GradCam scores. The significant results from our analysis unprecedently allowed a more detailed, and biologically relevant understanding of the cytoskeletal changes that accompany oncogenic transformation of normal to invasive and metastasizing cells. We also paved the way for a possible spatial micrometre-level biomarker for future development of diagnostic tools against metastasis (spatial distribution of vimentin)

Millennium: big effort has produced statistical results

Millennium: big effort has produced statistical result

Structure effects on the ionicity of protic ionic liquids

We report on the characterisation of 16 protic ionic liquids (PILs) prepared by neutralization of primary or tertiary amines with a range of simple carboxylic acids, or salicylic acid. The extent of proton transfer was greater for simple primary amine ILs compared to tertiary amines. For the latter case, proton transfer was increased by providing a better solvation environment for the ions through the addition of a hydroxyl group, either on the tertiary amine, or by formation of PIL/molecular solvent mixtures. The library of PILs was characterised by DSC and a range of transport properties (i.e. viscosity, conductivity and diffusivity) were measured. Using the (fractional) Walden rule, the conductivity and viscosity results were analysed with respect to their deviation from ideal behaviour. The validity of the Walden plot for PILs containing ions of varying sizes was also verified for a number of samples by directly measuring self‐diffusion coefficients using pulsed‐field gradient spin‐echo (PGSE) NMR. Ionicity was found to decrease as the alkyl chain length and degree of branching of both the cations and anions was increased. These results aim to develop a better understanding of the relationship between PIL properties and structure, to help design ILs with optimal properties for applications

Probing the dynamic nature of self-assembling cyclic peptide-polymer nanotubes in solution and in mammalian cells

Self-assembling cyclic peptide–polymer nanotubes have emerged as a fascinating supramolecular system, well suited for a diverse range of biomedical applications. Due to their well-defined diameter, tunable peptide anatomy, and ability to disassemble in situ, they have been investigated as promising materials for numerous applications including biosensors, antimicrobials, and drug delivery. Despite this continuous effort, the underlying mechanisms of assembly and disassembly are still not fully understood. In particular, the exchange of units between individual assembled nanotubes has been overlooked so far, despite its knowledge being essential for understanding their behavior in different environments. To investigate the dynamic nature of these systems, cyclic peptide–polymer nanotubes are synthesized, conjugated with complementary dyes, which undergo a Förster resonance energy transfer (FRET) in close proximity. Model conjugates enable to demonstrate not only that their self-assembly is highly dynamic and not kinetically trapped, but also that the self-assembly of the conjugates is strongly influenced by both solvent and concentration. Additionally, the versatility of the FRET system allows studying the dynamic exchange of these systems in mammalian cells in vitro using confocal microscopy, demonstrating the exchange of subunits between assembled nanotubes in the highly complex environment of a cell