Applying a participatory action research model to assess and address community health concerns among tribal communities in Gujarat, Western India : the potential and challenges of participatory approaches

Scheduled Tribes are a highly marginalised minority population in India as a result of discrimination and oppression of the historic caste system that still exists post-independence. Poverty is endemic amongst the tribal population along with poor health indicators disparate to those of the broader population. It is within this challenging environment of layered disparity (geographical, socio-cultural, gendered and socio-economical) in addition to tribalism, casteism and conflict with government and corporate structures, that this international collaborative research study was undertaken. Using a multi-stage approach, the objective of this study was to explore community perceptions of health issues in five rural, tribal villages in Gujarat, Western India and transform community knowledge into action. A modified framework of the widely used applied research methodology, participatory action research (PAR) was used for this study.Stage 1 generated knowledge of community health problems by applying rapid participatory appraisal (RPA). Based on the knowledge and perceptions of the local community, and using the RPA information pyramid as a framework, data was collected from each village in 2009, using a combination of semi structured interviews with community key informants, direct observation through community visits, focus group interviews and review of existing records. In total, 82 people were interviewed throughout the RPA process. Later returning to communities, a process of confirming and prioritising the health concerns was undertaken in preparation for Stage 2.Community based participatory research (CBPR), an action focused approach, was applied in Stage 2 to design action-interventions to address community prioritised health issues. In the early stages of Stage 2, the practicality of developing and implementing action-interventions was impeded by multiple contextual, social and cultural factors and the research was discontinued before completing a full cycle of PAR. To further understand the complexities of working with communities for change, insider perspectives and experiences of working with local communities towards empowerment and social change were sought from eight key informants, contributing to further understanding of the study.The results of this study reveal the priority health issues identified by the communities, uncover challenges inherent in participatory research, and present key informants’ perspectives of their work with marginalised communities. The RPA results provided a documentation of community-identified and prioritised health problems in each of the five selected study villages. Alcohol abuse was endemic in all study villages. Sanitation issues were also significant with 50% of homes in some villages having no access to toilets. Further issues of concern were environmental pollution, access to and quality of health care, road traffic safety, and underlying poverty. The employed participatory methods produced new shared knowledge unique to this study setting. For the first time, perceptions and voices of marginalised communities in these villages have been recorded, study findings compiled and distributed among the community.The transparent audit trail of activity in Stage 2 of the research combined with the documented perspectives of local social activists informed the discussion on the challenges of participatory research approaches in complex environments. It also provided information to further modify the PAR framework for future application. The resultant modified framework presents a practical approach and proposes some new improvements to practice when working with communities for knowledge generation through needs assessments, to needs-based action-interventions. Its combination of theoretical and practical considerations makes it suitable for non-government organisations (NGO), field practitioners and academics.The researcher argues that tested methodologies, approaches and methods alone cannot ensure a successful outcome to the knowledge to action transition and subsequently, PAR approaches. External factors separate from methodological decisions impact on a study and combined with the complex nature of community problems can cause less than desired outcomes. A recommendation is made for further research into these factors, as resources may be better directed by assessing if community efforts are likely to evoke action, leading to beneficial change. Whilst participatory action research is inherently challenging when applied in disadvantaged communities in complex environments, there is hope that with continual improvements community led action can bring about change for the communities where the applied research is undertaken

Improving Delivery of Secondary Prophylaxis for Rheumatic Heart Disease in a High-Burden Setting: Outcome of a Stepped-Wedge, Community, Randomized Trial

BACKGROUND Health system strengthening is needed to improve delivery of secondary prophylaxis against rheumatic heart disease. METHODS AND RESULTS We undertook a stepped-wedge, randomized trial in northern Australia. Five pairs of Indigenous community clinics entered the study at 3-month steps. Study phases comprised a 12 month baseline phase, 3 month transition phase, 12 month intensive phase and a 3- to 12-month maintenance phase. Clinics received a multicomponent intervention supporting activities to improve penicillin delivery, aligned with the chronic care model, with continuous quality-improvement feedback on adherence. The primary outcome was the proportion receiving ≥80% of scheduled penicillin injections. Secondary outcomes included "days at risk" of acute rheumatic fever recurrence related to late penicillin and acute rheumatic fever recurrence rates. Overall, 304 patients requiring prophylaxis were eligible. The proportion receiving ≥80% of scheduled injections during baseline was 141 of 304 (46%)-higher than anticipated. No effect attributable to the study was evident: in the intensive phase, 126 of 304 (41%) received ≥80% of scheduled injections (odds ratio compared with baseline: 0.78; 95% confidence interval, 0.54-1.11). There was modest improvement in the maintenance phase among high-adhering patients (43% received ≥90% of injections versus 30% [baseline] and 28% [intensive], P<0.001). Also, the proportion of days at risk in the whole cohort decreased in the maintenance phase (0.28 versus 0.32 [baseline] and 0.34 [intensive], P=0.001). Acute rheumatic fever recurrence rates did not differ between study sites during the intensive phase and the whole jurisdiction (3.0 versus 3.5 recurrences per 100 patient-years, P=0.65). CONCLUSIONS This strategy did not improve adherence to rheumatic heart disease secondary prophylaxis within the study time frame. Longer term primary care strengthening strategies are needed. CLINICAL TRIAL REGISTRATION URL: www.anzctr.org.au. Unique identifier: ACTRN12613000223730

Modeling the Martian dust cycle 2. Multiannual radiatively active dust transport simulations

Multiannual dust transport simulations have been performed using a Mars general circulation model containing a dust transport scheme which responds to changes in the atmospheric state. If the dust transport is 'radiatively active,� the atmospheric state also responds to changes in the dust distribution. This paper examines the suspended dust distribution obtained using different lifting parameterizations, including an analysis of dust storms produced spontaneously during these simulations. The lifting mechanisms selected are lifting by (1) near-surface wind stress and (2) convective vortices known as dust devils. Each mechanism is separated into two types of parameterization: threshold-sensitive and -insensitive. The latter produce largely unrealistic annual dust cycles and storms, and no significant interannual variability. The threshold-sensitive parameterizations produce more realistic annual and interannual behavior, as well as storms with similarities to observed events, thus providing insight into how real Martian dust storms may develop. Simulations for which dust devil lifting dominates are too dusty during northern summer. This suggests either that a removal mechanism (such as dust scavenging by water ice) reduces opacities at this time or that dust devils are not the primary mechanism for storm production. Simulations for which near-surface wind stress lifting dominates produce the observed low opacities during northern spring/summer, yet appear unable to produce realistic global storms without storm decay being prevented by the occurrence of large-scale positive feedbacks on further lifting. Simulated dust levels are generally linked closely to the seasonal state of the atmosphere, and no simulation produces the observed amount of interannual variability

Nonequilibrium thermodynamics of circulation regimes in optically-thin, dry atmospheres

An extensive analysis of an optically-thin, dry atmosphere at different values of the thermal Rossby number Ro and of the Taylor number Ff is per- formed with a general circulation model by varying the rotation rate {\Omega} and the surface drag {\tau} in a wide parametric range. By using nonequilibrium thermodynamics diagnostics such as material entropy production, efficiency, meridional heat transport and kinetic energy dissipation we characterize in a new way the different circulation regimes. Baroclinic circulations feature high mechanical dissipation, meridional heat transport, material entropy pro- duction and are fairly efficient in converting heat into mechanical work. The thermal dissipation associated with the sensible heat flux is found to depend mainly on the surface properties, almost independent from the rotation rate and very low for quasi-barotropic circulations and regimes approaching equa- torial super-rotation. Slowly rotating, axisymmetric circulations have the highest meridional heat transport. At high rotation rates and intermediate- high drag, atmospheric circulations are zonostrohic with very low mechanical dissipation, meridional heat transport and efficiency. When {\tau} is interpreted as a tunable parameter associated with the turbulent boundary layer trans- fer of momentum and sensible heat, our results confirm the possibility of using the Maximum Entropy Production Principle as a tuning guideline in the range of values of {\Omega}. This study suggests the effectiveness of using fun- damental nonequilibrium thermodynamics for investigating the properties of planetary atmospheres and extends our knowledge of the thermodynamics of the atmospheric circulation regimes

Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis

BACKGROUND Rheumatic heart disease is a high-burden condition in Australian Aboriginal communities. We evaluated a stepped-wedge, community, randomized trial at 10 Aboriginal communities from 2013 to 2015. A multifaceted intervention was implemented using quality improvement and chronic care model approaches to improve delivery of penicillin prophylaxis for rheumatic heart disease. The trial did not improve penicillin adherence. This mixed-methods evaluation, designed a priori, aimed to determine the association between methodological approaches and outcomes. METHODS AND RESULTS An evaluation framework was developed to measure the success of project implementation and of the underlying program theory. The program theory posited that penicillin delivery would be improved through activities implemented at clinics that addressed elements of the chronic care model. Qualitative data were derived from interviews with health-center staff, informants, and clients; participant observation; and project officer reports. Quantitative data comprised numbers and types of "action items," which were developed by participating clinic staff with project officers to improve delivery of penicillin injections. Interview data from 121 health-center staff, 22 informants, and 72 clients revealed barriers to achieving the trial's aims, including project-level factors (short trial duration), implementation factors (types of activities implemented), and contextual factors (high staff turnover and the complex sociocultural environment). Insufficient actions were implemented addressing "self-management support" and "community linkage" streams of the chronic care model. Increased momentum was evident in later stages of the study. CONCLUSIONS The program theory underpinning the study was sound. The limited impact made by the study on adherence was attributable to complex implementation challenges.This study was funded by the Australian National Health and Medical Research Council (NHMRC) project grant 1027040 and Center of Research Excellence 1080401 and by the Wesfarmers Center for Vaccines and Infectious Diseases at Telethon Kids Institute. Ralph and Maguire are supported by NHMRC fellowships (1142011 and 1046563, respectively)

Atmospheric tides in a Mars general circulation model with data assimilation

The prominence of thermal tides in the Martian atmosphere has long been recognized, through classical theory, models and observations, including surface pressure records from the Viking and Mars Pathfinder Landers. A unique record of observations over more than two Martian years is now available from the Mars Global Surveyor spacecraft, although since the spacecraft is Sun-synchronous it is difficult to extract information about many tidal modes directly. Data assimilation is a technique by which observations may be combined with a Mars general circulation model (MGCM) to produce a consistent, time-evolving global analysis. Thermal and total dust opacity measurements derived from the Thermal Emission Spectrometer have been assimilated into the Oxford MGCM and the tidal modes analysed from the model surface pressure record produced by this process. Periods around regional and global dust storm events show strong, characteristic tidal signatures in the assimilations

Specificity determinants for lysine incorporation in staphylococcus aureus peptidoglycan as revealed by the structure of a MurE enzyme ternary complex

Background: MurE controls stereo chemical incorporation of Lysine or diaminopimelate into peptidoglycan stem peptides Results: The structure of S.aureus MurE reveals an unexpected lack of specificity for Lysine within the active site. Conclusion: Incorporation of Lysine is supported by the comparatively high concentration of cytoplasmic lysine, not enzyme specificity. Significance: This study provides new perspectives in targeting Gram-positive peptidoglycan assembly for antimicrobial discovery

Characterization of the nighttime low‐latitude water ice deposits in the NASA Ames Mars General Circulation Model 2.1 under present‐day atmospheric conditions

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94673/1/jgre2617.pd

Diurnal Variation in Martian Dust Devil Activity

We show that the dust devil parameterisation in use in most Mars Global Circulation Models (MGCMs) results in an unexpectedly high level of dust devil activity during morning hours. Prior expectations of the diurnal variation of Martian dust devils are based mainly upon the observed behaviour of terrestrial dust devils: i.e. that the majority occur during the afternoon. We instead find that large areas of the Martian surface experience dust devil activity during the morning in our MGCM, and that many locations experience a peak in dust devil activity before mid-sol. We find that the diurnal variation in dust devil activity is governed by near-surface wind speeds. Within the range of daylight hours, higher wind speeds tend to produce higher levels of dust devil activity, rather than the activity simply being governed by the availability of heat at the planet's surface, which peaks in early afternoon. Evidence for whether the phenomenon we observe is real or an artefact of the parameterisation is inconclusive. We compare our results with surface-based observations of Martian dust devil timings and obtain a good match with the majority of surveys. We do not find a good match with orbital observations, which identify a diurnal distribution more closely matching that of terrestrial dust devils, but orbital observations have limited temporal coverage, biased towards the early afternoon. We propose that the generally accepted description of dust devil behaviour on Mars is incomplete, and that theories of dust devil formation may need to be modified specifically for the Martian environment. Further surveys of dust devil observations are required to support any such modifications. These surveys should include both surface and orbital observations, and the range of observations must encompass the full diurnal period and consider the wider meteorological context surrounding the observations

Structure and dynamics of the Martian lower and middle atmosphere as observed by the Mars Climate Sounder: Seasonal variations in zonal mean temperature, dust, and water ice aerosols

The first Martian year and a half of observations by the Mars Climate Sounder aboard the Mars Reconnaissance Orbiter has revealed new details of the thermal structure and distributions of dust and water ice in the atmosphere. The Martian atmosphere is shown in the observations by the Mars Climate Sounder to vary seasonally between two modes: a symmetrical equinoctial structure with middle atmosphere polar warming and a solstitial structure with an intense middle atmosphere polar warming overlying a deep winter polar vortex. The dust distribution, in particular, is more complex than appreciated before the advent of these high (~5 km) vertical resolution observations, which extend from near the surface to above 80 km and yield 13 dayside and 13 nightside pole-to-pole cross sections each day. Among the new features noted is a persistent maximum in dust mass mixing ratio at 15–25 km above the surface (at least on the nightside) during northern spring and summer. The water ice distribution is very sensitive to the diurnal and seasonal variation of temperature and is a good tracer of the vertically propagating tide