How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda

Background Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health. Village volunteers were taught how to generate change ideas to improve health-seeking behaviours and home-based maternal and newborn care practices. Interaction was encouraged between communities and health staff. Aim To describe experiences implementing EQUIP’s QI approach at the community level. Methods A mixed methods process evaluation of community-level QI was conducted in Tanzania and a feasibility study in Uganda. We outlined how village volunteers were trained in and applied QI techniques and examined the interaction between village volunteers and health facilities, and in Tanzania, the interaction with the wider community also. Results Village volunteers had the capacity to learn and apply QI techniques to address local maternal and neonatal health problems. Data collection and presentation was a persistent challenge for village volunteers, overcome through intensive continuous mentoring and coaching. Village volunteers complemented health facility staff, particularly to reinforce behaviour change on health facility delivery and birth preparedness. There was some evidence of changing social norms around maternal and newborn health, which EQUIP helped to reinforce. Conclusions Community-level QI is a participatory research approach that engaged volunteers in Tanzania and Uganda, putting them in a central position within local health systems to increase health-seeking behaviours and improve preventative maternal and newborn health practices

ERP correlates of item recognition memory: Effects of age and performance

Decline in episodic memory is a common feature of healthy aging. Event-related potential (ERP) studies in young adults have consistently reported several modulations thought to index memory retrieval processes, but relatively limited work has explored the impact of aging on them. Further, work with functional imaging has demonstrated differential neural recruitment in elderly subjects depending on their level of cognitive performance which may reflect compensatory or, alternatively, inefficient processing. In the present study we examined the effect of aging and level of performance on both early (FN400, LPC) and later [late frontal effect (LFE)] ERP indices of recognition memory. We found that the FN400 and LPC were absent or attenuated in the older group relative to young adults, but that the LFE was actually increased, analogous to findings in the functional imaging literature. Additionally, the latter effect was most prominent in the poorer performing older participants. These findings suggest that weak memory retrieval supported by earlier ERP modulations, may lead to an enhanced LFE in the service of additional retrieval attempts

ERP correlates of remember/know decisions: association with the late posterior negativity

Abstract A number of studies have utilized the Remember/Know paradigm to determine event-related potential (ERP) correlates of recollection and familiarity. However, no prior work has been specifically directed at examining the processing involved in making the Remember/Know distinction. The following study employed a two-step recognition memory test in which participants first decided whether they recognized a word from a prior study list (Old/New decision); if they did, they then determined whether it was recognized on the basis of recollection ('Remember' responses) or familiarity ('Know' responses). By time-locking ERPs to the initial Old/New decision, processing related to making the introspective Remember/Know judgment was isolated. This methodology revealed a posterior negativity that was largest for 'Remember' responses. Previous work has described a late posterior negativity which appears to be related to the search for and recapitulation of study details. Such processing may be critical in making Remember/Know determinations.

The Relevance of Maintaining Standing Forests for Global Climate Balance: A Case Study in Brazilian Forests

Estimate Net Ecosystem Exchange (NEE) is important to better understand carbon exchanges between terrestrial ecosystems and the atmosphere. Comprehend these dynamics is essential to better understand the responses of environments to ongoing climatic changes. This study aims to analyze, with AMERIFLUX and LBA network measurements, the variability of NEE and climate variables in four different tropical coverages: Pantanal, Amazonia, Caatinga and Cerrado (savanna). Furthermore, was estimate the Gross Primary Productivity (GPP). We found a distinct seasonality of meteorological variables and CO2 fluxes in each site. Despite acting mostly as a CO2 sink, some environments already show worrying source data in certain periods, pointed out as a direct effect of the reduction of photosynthesis caused by land use changes. The preserved forest plays an important role in maintaining rainfall at a regional and global level, and its maintenance makes it possible, by the way, an important tool in combating global warming via carbon sequestration by trees, which requires commitment and public policies of environmental preservation and recovery of degraded areas

Enfermagem moderna: a ordem do cuidado Enfermería Moderna: el orden del cuidado Modern nursing: the order of care

Com o propósito de colocar em foco a enfermagem moderna, faço neste ensaio uma leitura das condições de possibilidade do surgimento do regime de práticas da enfermagem. Apoiada por textos de Michel Foucault e identificada com os Estudos Culturais resgato fragmentos da história da enfermagem para reconstituir a organização de seu regime de práticas, num determinado momento histórico e no ambiente hospitalar. Conto a história de algumas das personagens desse enredo mostrando que o passado pode ser um produto do presente, já que encerra uma escrita da história construída e moldada pela vontade de seus autores. Destaco a enfermagem moderna como uma prática de cuidados que se profissionaliza e constrói um saber próprio que pretende assegurar independência profissional.<br>Con el propósito de colocar en foco la enfermería moderna, hago en este ensayo una lectura de las condiciones de posibilidad del surgimiento del régimen de prácticas de la enfermería. Apoyada por textos de Michel Foucault e identificada con los Estudios Culturales rescato fragmentos de la historia de la enfermería para reconstituir la organización de su régimen de prácticas, en un determinado momento histórico y en el ambiente hospitalario. Cuento la historia de algunos de los personajes de ese enredo mostrando que el pasado puede ser un producto del presente, ya que termina una escritura de la historia construida y moldeada por las ganas de sus autores. Destaco la enfermería moderna como una práctica de cuidados que se profesionaliza y construye un saber propio que pretende asegurar independencia profesional.<br>With the purpose of placing modern nursing into focus, in this essay I go over the possible conditions for the emergence of nursing practice systems. Based on texts by Michel Foucault and identified with Cultural Studies, I reclaim fragments from nursing history in order to put back together the organization of its practice system at a given historical moment and in a hospital environment. I tell the story of some of this plot's characters in an effort to show that the past can become the product of the present, once it encompasses historical writings devised and set up by the will of its authors. I highlight modern nursing as a practice of care that becomes professional and builds its own knowledge intent on ensuring professional independence