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

Constituição de competências para a intervenção no processo saúde-doença da população: desafio ao educador de enfermagem Constitución de competencias para la intervención del proceso de salud-enfermedad de la población: desafío a el educador de enfermería Constitution of knowledge for the intervention of health and disease processe of the population: a challenge for educator in nursing

Tomando como objeto de estudo a prática educativa - ensino e avaliação - operada no Estágio Rural Integrado da Universidade Federal da Paraíba, os autores discutem sobre a centralidade dos conhecimentos nesta prática educativa e consideram a possibilidade de se implantar processos de ensino e avaliação transformadores, ancorados na abordagem pedagógica por Competências. Propõem a utilização desta abordagem e da metodologia da TIPESC - Teoria da Intervenção Práxica da Enfermagem em Saúde Coletiva como orientadores dos processos de formação de força de trabalho em saúde e, em particular de enfermagem, visando à constituição de sujeitos críticos e reflexivos que atendam aos requerimentos do Sistema Único de Saúde.<br>Tomando como objeto de estudio la práctica educativa (docencia y evaluación) operada en el Estagio Rural Integrado de la Universidade Federal da Paraíba, los autores discuten sobre la centralidad de los conocimientos en esta práctica educativa y consideran la posibilidad de implantar procesos de docencia y evaluación transformadores basados en el abordaje pedagógico por competencias. Proponen la utilización de este abordaje y de la metodología de la TIPESC - Teoria de la Intervención Práxica de la Enfermeria en la Salud Colectiva como orientadores de los procesos de formación de fuerza de trabajo en la salud y, en particular, de enfermería, objetivando la constitución de sujetos críticos y reflexivos que atiendan a los requisitos del Sistema Único de Salud, en esta área.<br>Having as an object of study the educational practice - teaching and evaluation - as carried out in the Estágio Rural Integrado of the Federal University of Paraíba, the researchers discuss the relevance of knowledge concerning this educational practice and consider the possibility of implementing processes of teaching and evaluation that may operate transformations. In order to reach this goal, their study is supported by the Competence pedagogical approach. They propose this approach and the methodology underlying TIPESC - Theory of Nursing Practical Intervention in Collective Health - as guiding lines for the processes of the formation and training of health professionals, particularly those in the area of nursing. This aims for the development of critical and reflexive personnel that may respond to the requirements of the Sistema Único de Saúde

Are Endogenous BMPs Necessary for Bone Healing during Distraction Osteogenesis?

Previous reports suggest the application of exogenous BMPs can accelerate bone formation during distraction osteogenesis (DO). However, there are drawbacks associated with the use of exogenous BMPs. A possible alternative to the use of exogenous BMPs is to upregulate the expression of endogenous BMPs. Since DO results in spontaneously generated de novo bone formation in a uniform radiographic, histological, and biomechanical temporal sequence, a genetically engineered model lacking endogenous BMP2 should have measurable deficits in bone formation at different time points. We performed DO on BMP2 fl/+ and BMP2 fl/+ cre mice using a miniature Ilizarov fixator. Distracted samples were collected at various time points and analyzed using Real Time-quantitative PCR, μCT, radiology, immunohistochemistry, histology, and biomechanical testing. Immunohistochemical studies of 34-day heterozygous samples showed reduced expression of BMP2, BMP7, BMPR1a, ACTR1, and ACTR2b. μCT analysis of 51-day heterozygous samples revealed a decrease in trabecular number and increase in trabecular separation. Biomechanical testing of 51-day heterozygous samples revealed decreased stiffness and increased ultimate displacement. Radiological analysis showed the heterozygotes contained a decreased bone fill score at 17, 34, and 51 days. These data suggest endogenous BMPs are important for bone healing and manipulating endogenous BMPs may help accelerate bone consolidation during DO

IceCube: A multipurpose neutrino telescope

IceCube is a new high-energy neutrino telescope which will be coming online in the near future. IceCube will be capable of measuring fluxes of all three flavors of neutrino, and its peak neutrino energy sensitivity will be in the TeV-PeV range. Here, after a brief description of the detector, we describe its anticipated performance with a selection of physics topics: supernovae, extraterrestrial diffuse and point sources of neutrinos, gamma-ray bursts, neutrinos from WIMP annihilation, and cosmic ray composition. \ua9 2008 The Physical Society of Japan

Conflicting values: ecosystem services and invasive tree management

Tree species have been planted widely beyond their native ranges to provide or enhance ecosystem services such as timber and fibre production, erosion control, and aesthetic or amenity benefits. At the same time, non-native tree species can have strongly negative impacts on ecosystem services when they naturalize and subsequently become invasive and disrupt or transform communities and ecosystems. The dichotomy between positive and negative effects on ecosystem services has led to significant conflicts over the removal of non-native invasive tree species worldwide. These conflicts are often viewed in only a local context but we suggest that a global synthesis sheds important light on the dimensions of the phenomenon. We collated examples of conflict surrounding the control or management of tree invasions where conflict has caused delay, increased cost, or cessation of projects aimed at invasive tree removal. We found that conflicts span a diverse range of taxa, systems and countries, and that most conflicts emerge around three areas: urban and near-urban trees; trees that provide direct economic benefits; and invasive trees that are used by native species for habitat or food. We suggest that such conflict should be seen as a normal occurrence in invasive tree removal. Assessing both positive and negative effects of invasive species on multiple ecosystem services may provide a useful framework for the resolution of conflicts