The Addis Agreement: Using CLTS in peri-urban and urban areas

The CLTS Knowledge Hub with the support of Plan International Ethiopia, convened a three day workshop focusing on ‘Using a CLTS Approach and Tools in Peri-Urban and Urban Environments’ in Addis Ababa in June 2016. Over the course of three days participants from across the world and different organisations shared their experiences with urban CLTS and discussed what added value a CLTS approach in the urban context could bring. This Learning Paper has two purposes. It can be read as a record of the different discussions that took place. However, it is much more than a workshop report. Based on practical examples of what has worked it highlights the key stages of any urban CLTS programme. Furthermore, it provides guidance, advice and experiences of these different stages. Its purpose is not a guide but the beginnings of a toolbox for those interested in following a similar approach

Using a CLTS Approach in Peri-Urban and Urban Environments: Potential at Scale

This note summarises the potentials and limitations of using a CLTS approach in peri-urban and urban environments. It identifies the actions needed to take the approach to scale. It is one output from a workshop convened by the CLTS Knowledge Hub at the Institute of Development Studies, and Plan International Ethiopia in Addis Abba between June 13th-15th 2016. A more detailed report can be found on the CLTS Knowledge Hub website: www.communityledtotalsanitation.org/resource/using-clts-approach-peri-urban-and-urban-environmentsThis series is funded by the Swedish International Development Cooperation (Sida)

Structures of Two Diastereomeric Aldol Products from a New Silicon-Directed Condensation

Hexahydro-3,3,6-trimethyl-5-phenyl- 1 H,7H-pyrrolo[2,1-e][1,3,6,2]dioxazasilonin-7-one, C17H25NO3Si, Mr=319.48. (2S,3R)-anti-Diastereomer (I), orthorhombic, P212121, a= 8-716(4), b=11-677(3), c=17.161(6)A, V=1746(1)A3, Z=4, Dx=1.22 g cm-3, wavelength(Mo Kce) = 0.71073 A, u=1.50 cm-1 F(000)=688, room temperature, final R=0.040 for 1683 reflections with Fo2 greater than 0. (2S,3S)-syn- Diastereomer (II), monoclinic, P21, a=6.633(2), b=14.645(3), c=9.630(2) A, Beta=109.96(2)o, V=879.3(4) A3, Z=2, Dx=1.21 g cm-3, wavelength(Mo Ka)=0.71073 A,u = 1-49 cm-1, F(000)=344, room temperature, final R = 0.042 for 2537 reflections with F2o greater than 0. The compounds have a nine-membered hetero-cyclic ring containing the Si atom, the N atom of the pyrrolidine ring, two O atoms bonded to silicon and a carbonyl C atom. Bond distances in the molecules are normal and equivalent bonds are equal within three times their e.s.d.'s. Isomer (I) shows a disorder in the pyrrolidine ring that is absent in isomer (II).Chemistry and Chemical Biolog

Clinical Instructor Perceptions of the Collaborative Clinical Education Model: Providing Solutions for Success in Physical Therapy Education

Purpose: The most common approach to physical therapy clinical education is the one-to-one (1:1) model. The collaborative clinical education model (CCEM) offers an alternative and beneficial approach to education but is not widely utilized within physical therapy. The primary aim of this study was to explore the experiences and perceptions of clinical instructors (CIs) teaching within the CCEM while also receiving structured support from an academic program. Methods: This study used semi-structured interviews before and after the CCEM experience to explore CI perceptions. CIs received formalized support that included pre-experience meetings, a CCEM Toolkit resource, scheduled follow-ups during the experience, and a post-clinical debriefing. Interview transcripts were analyzed using a qualitative data analysis program and collaborative coding process. Results: CIs’ perceptions of the CCEM shifted following participation. Participants noted a need to be prepared with appropriate teaching strategies, have frequent communication with the academic program, and have a supportive clinical environment. Conclusion: CI participation in the CCEM is challenged by negative perceptions and lack of experience with collaborative learning. CI perceptions of the CCEM can become more positive after actually teaching in the CCEM; therefore, perceived challenges need to be addressed to increase CI participation. The CCEM may be more widely accepted if CIs’ perceived challenges are addressed in partnership with an academic program with intentional CCEM training and support strategies

The Clinical User-experience Evaluation (CUE) – a novel method to understand patient's experience in a clinical trial of telemedicine

Research Objective: The use of technology-enabled interventions such as telemedicine to monitor patients from home is on the increase with chronic diseases. Telemedicine technologies are often designed ad-hoc by IT developers but how patients interact and feel about using these technologies in the rollout phase is crucial because the effectiveness of a telemedicine treatment also depends on the interaction pattern between the technology and its users (patients). While clinical trials focus on assessing the effectiveness of telemedicine other study designs are needed to investigate patients' experiences with the technologies. We developed a novel qualitative methodology - the Clinical User-Experience Evaluation (CUE) - to complement a clinical trial, using evaluation methods from Human-Computer Interaction (HCI) discipline. The CUE was implemented within a telemedicine clinical trial of Type 2 Diabetes (T2D) in Townsville region in Queensland in Australia, conducted by the TMML (Townsville-Mackay Medicare Locals). The telemedicine trial consisted of a tablet equipped with a built-in app, a glucometer and a sphygmomanometer. Study Design: We developed the CUE as a three-stage method. Stage 1 was a contextual inquiry that was performed in-situ at a patient's home. Patients used the tablet with the think-aloud method during this stage, during regularly scheduled times for using the technology. Stage 2 of CUE was a semi-structured qualitative inquiry to understand patients' experience and expectations including questions that arose during stage 1. Stage 3 was an online survey to verify some of our observations from the previous stages. Population Studied: Nine T2D patients (four females, five males) volunteered to participate in the CUE. They were part of the 210 participants of TMML's telemedicine clinical trial. Principal Findings: Stage 1 found that the technology did not suffice all of the needs of patients; they additionally used pen and paper. Stage 2 found patients' emotions, perceived behavior change of using the technology, reasons to use or not use the technology in future. Stage 3 tested what patients thought about seven of our observations about them. A few important ones were that - patients were divided in their opinion about –contacting nurses about technology related problems, about changing the location of the technology in their homes and that they were informed about expressing their thoughts about the technology design even though the clinical trial was about their medical improvement. However, all patients agreed that talking with a HCI researcher was additionally valuable for them. Interviews with two nurses validated that CUE acquired additional knowledge than those from the trial. Conclusions: Evaluation of telemedicine technologies can benefit through evaluation methods like CUE in addition to clinical trials. Implications for Policy or Practice: Some clinical trials are conducting a patient satisfaction survey only in the end and some additionally conduct qualitative studies. However, these are not done from a HCI perspective. The CUE uses HCI evaluation in a clinical trial understand the patients throughout the trial to find how patients feel and what matters to patients in a telemedicine technology and these findings provide guidance towards the modification of the technology or new technologies of telemedicine

Structure of an anti-Aldol Addition Product of Benzaldehyde and a Pseudoephedrine-Derived O-Silyl Ketene N,O-Acetal

[4S-(4R*,5R*,8R*,9S*)]-2,2,5,6,8-Penta- methyl-4,9-diphenyl- 1,3-dioxa-6-aza-2-silacyclono-nan-7-one, CE2H29NO3Si, Mr = 383.56, monoclinic, P21, a = 6.550 (3), b = 17.318 (6), c = 20.129 (6) A, /3=98.83(3)° , V =2256.2(14) A 3, Z=4, Dx= 1.13 gcm -3, A(Mo Ka) = 0.71073 A,/z = 1.18 cm -1, F(000) = 824, room temperature, R on F = 0.039 for 4305 reflections with Fo 2 > 3cr(Fo2). The two independent molecules in this structure have nearly the same configuration and geometry. The Si atoms are tetrahedrally coordinated, with average Si--C bond distances of 1.842(3)/~ and average Si---O bond distances of 1.636 (7)A; angles at Si differ from 109.5 ° by an average of 3.5 °. The nine-membered rings are fully extended and the planes of the phenyl groups are approximately perpendicular to the nine- membered ring.Chemistry and Chemical Biolog

PICES Advisory Report on the decline of Fraser River sockeye salmon Oncorhynchus nerka (Steller, 1743) in relation to marine ecology

In the spring of 2010, the Government of Canada invited PICES to participate in a Commission of Inquiry into the Decline of Sockeye Salmon in the Fraser River by considering how marine ecology may have affected their abundance. A major objective that was achieved in this report was to assemble, within an eight week period, as comprehensive a summary as was possible of what is known about Fraser River sockeye salmon (Oncorhynchus nerka) in the ocean. While much of this effort involved summarizing information published in data/technical reports and the primary literature, where necessary, original data have been re-examined and new analyses conducted to fulfill the terms of the Statement of Work. The compilation provides a background of knowledge against which to judge what can be known regarding the two major questions posed by the Cohen Commission to PICES: -Can the decline in Fraser River sockeye in 2009 be explained by the conditions the fish experienced in the marine environment? -Is there any evidence for declines in marine productivity or changes in Fraser River sockeye distribution that can be associated with the 15-year gradual decrease in Fraser River sockeye productivity

Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia

Background: Evidence-based brief psychological interventions are safe and effective for the treatment of antenatal depressive symptoms. However, the adaptation of such interventions for low- and middle-income countries has not been prioritised. This study aimed to select and adapt a brief psychological intervention for women with antenatal depressive symptoms attending primary healthcare (PHC) in rural Ethiopia. Methods: We employed the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. Alongside this, we used the ADAPT-ITT model of process adaptation and the ecological validity model (EVM) to guide content adaptation. We conducted formative work, comprising a qualitative study, a series of three participatory theories of change workshops and an expert adaptation workshop to assess the needs of the target population and to select an intervention for adaptation. The adaptation process followed a series of steps: (1) training Ethiopian mental health experts in the original South African problem-solving therapy (PST version 0.0) and an initial adaptation workshop leading to PST Version 1.0. (2) Version 1.0 was presented to perinatal women and healthcare professionals in the form of a ‘theatre test’, leading to further adaptations (version 2.0). (3) Local and international stakeholders reviewed version 2.0, leading to version 3.0, which was used to train 12 PHC staff using clinical cases. (4) Finally, feedback about PST version 3.0 and its delivery was obtained from PHC staff. Results: In the first step, we modified case examples and terminology from the South African model, introduced an in-session pictorial flipchart for this low literacy setting, and added strategies to facilitate women’s engagement before translating into Amharic. In the second step, adaptations included renaming of the types of problems and inclusion of more exercises to demonstrate proposed coping strategies. In the third step, the components of motivational interviewing were dropped due to cultural incongruence. In the final step, refresher training was delivered as well as additional training on supporting control of women’s emotions to address PHC staff training needs, leading to the final version (version 4.0). Conclusion: Using a series of steps, we have adapted the content and delivery of brief PST to fit the cultural context of this setting. The next step will be to assess the feasibility and acceptability of the intervention and its delivery in antenatal care settings