Obstacles to implementation of an intervention to improve surgical services in an Ethiopian hospital: a qualitative study of an international health partnership project.

BACKGROUND: Access to safe surgical care represents a critical gap in healthcare delivery and development in many low- and middle-income countries, including Ethiopia. Quality improvement (QI) initiatives at hospital level may contribute to closing this gap. Many such quality improvement initiatives are carried out through international health partnerships. Better understanding of how to optimise quality improvement in low-income settings is needed, including through partnership-based approaches. Drawing on a process evaluation of an intervention to improve surgical services in an Ethiopian hospital, this paper offers lessons to help meet this need. METHODS: We conducted a qualitative process evaluation of a quality improvement project which aimed to improve access to surgical services in an Ethiopian referral hospital through better management. Data was collected longitudinally and included: 66 in-depth interviews with surgical staff and project team members; observation (135 h) in the surgery department and of project meetings; project-related documentation. Thematic analysis, guided by theoretical constructs, focused on identifying obstacles to implementation. RESULTS: The project largely failed to achieve its goals. Key barriers related to project design, partnership working and the implementation context, and included: confusion over project objectives and project and partner roles and responsibilities; logistical challenges concerning overseas visits; difficulties in communication; gaps between the time and authority team members had and that needed to implement and engage other staff; limited strategies for addressing adaptive-as opposed to technical-challenges; effects of hierarchy and resource scarcity on QI efforts. While many of the obstacles identified are common to diverse settings, our findings highlight ways in which some features of low-income country contexts amplify these common challenges. CONCLUSION: We identify lessons for optimising the design and planning of quality improvement interventions within such challenging healthcare contexts, with specific reference to international partnership-based approaches. These include: the need for a funded lead-in phase to clarify and agree goals, roles, mutual expectations and communication strategies; explicitly incorporating adaptive, as well as technical, solutions; transparent management of resources and opportunities; leadership which takes account of both formal and informal power structures; and articulating links between project goals and wider organisational interests.This research was supported by funding from a Wellcome Trust Senior Investigator Award [WT097899M]. The Wellcome Trust had no role in the design or conduct of the research.This is the final version of the article. It first appeared from BioMed Central at http://dx.doi.org/10.1186/s12913-016-1639-4

Creating a learning environment to promote food sustainability issues in primary schools? Staff perceptions of implementing the food for life partnership programme

There is increasing interest in the role that schools can play in promoting education for sustainable development (ESD), and evidence is emerging that schools can be influential in the emerging agenda around the ecological, ethical and social aspects of food, diet and nutrition. With regard to such food sustainability issues, this paper analyses the role of the Food for Life Partnership national programme in supporting garden and farm-based learning activities in 55 primary schools in England, UK. Using a mixed methods approach, the study examined the programme's implementation through staff perceptions and a range of school change indicators. The study found that the programme delivery was associated with widespread institutional reforms. According to staff, implementation of the programme provided a range of opportunities for pupils to learn about food production and sustainability, but addressing these issues was challenging for teachers and raised a number of questions concerned with effective, equitable and on-going implementation. At a pedagogical level, teachers also reflected on conceptually challenging aspects of food sustainability as a topic for primary school education. The study identified ways that ESD programmes could support schools to think about and implement learning opportunities as well as identifying significant barriers related to resourcing such programmes. © 2013 by the authors; licensee MDPI, Basel, Switzerland

NIR Spectroscopy of Star-Forming Galaxies at z~1.4 with Subaru/FMOS: The Mass-Metallicity Relation

We present near-infrared spectroscopic observations of star-forming galaxies at z~1.4 with FMOS on the Subaru Telescope. We observed K-band selected galaxies in the SXDS/UDS fields with K10^{9.5} Msun, and expected F(Halpha)>10^{-16} erg s^{-1} cm^{-2}. 71 objects in the sample have significant detections of Halpha. For these objects, excluding possible AGNs identified from the BPT diagram, gas-phase metallicities are obtained from [NII]/Halpha line ratio. The sample is split into three stellar mass bins, and the spectra are stacked in each stellar mass bin. The mass-metallicity relation obtained at z~1.4 is located between those at z~0.8 and z~2.2. We constrain an intrinsic scatter to be ~0.1 dex or larger in the mass-metallicity relation at z~1.4; the scatter may be larger at higher redshifts. We found trends that the deviation from the mass-metallicity relation depends on the SFR and the half light radius: Galaxies with higher SFR and larger half light radii show lower metallicities at a given stellar mass. One possible scenario for the trends is the infall of pristine gas accreted from IGM or through merger events. Our data points show larger scatter than the fundamental metallicity relation (FMR) at z~0.1 and the average metallicities slightly deviate from the FMR. The compilation of the mass-metallicity relations at z~3 to z~0.1 shows that they evolve smoothly from z~3 to z~0 without changing the shape so much except for the massive part at z~0.Comment: 20 pages, 18 figures, accepted for publication in PAS

Exploring the spectral diversity of low-redshift Type Ia supernovae using the Palomar Transient Factory

We present an investigation of the optical spectra of 264 low-redshift (z < 0.2) Type Ia supernovae (SNe Ia) discovered by the Palomar Transient Factory, an untargeted transient survey. We focus on velocity and pseudo-equivalent width measurements of the Si II 4130, 5972, and 6355 A lines, as well those of the Ca II near-infrared (NIR) triplet, up to +5 days relative to the SN B-band maximum light. We find that a high-velocity component of the Ca II NIR triplet is needed to explain the spectrum in ~95 per cent of SNe Ia observed before -5 days, decreasing to ~80 per cent at maximum. The average velocity of the Ca II high-velocity component is ~8500 km/s higher than the photospheric component. We confirm previous results that SNe Ia around maximum light with a larger contribution from the high-velocity component relative to the photospheric component in their Ca II NIR feature have, on average, broader light curves and lower Ca II NIR photospheric velocities. We find that these relations are driven by both a stronger high-velocity component and a weaker contribution from the photospheric Ca II NIR component in broader light curve SNe Ia. We identify the presence of C II in very-early-time SN Ia spectra (before -10 days), finding that >40 per cent of SNe Ia observed at these phases show signs of unburnt material in their spectra, and that C II features are more likely to be found in SNe Ia having narrower light curves.Comment: 18 page, 10 figures, accepted for publication in MNRA

An occupational perspective of the lived experience of familial dementia caregivers : a thematic review of qualitative literature

Dementia caregiving is thought to have a negative impact on health and wellbeing. This critical review of qualitative literature explored the lived experience of familial dementia caregivers from an occupational therapy perspective. The method was informed by systematic review and qualitative research methodologies and was structured within the occupational dimensions framework of doing-being-becoming-belonging. A comprehensive search of major databases was undertaken which identified 484 studies on the topic; 14 met the inclusion criteria and were included in the review. Ten themes emerged within the doing-being-becoming-belonging framework from the analysis of the studies. The occupational participation of caregivers is conveyed within the ‘doing’ domain. Ways in which caregiving impacts upon opportunities for self-nurture are presented within the ‘being’ domain. The ‘becoming’ domain elucidates ways in which caregivers redefine themselves, their values and their priorities through their caregiving role. The ‘belonging’ domain depicts ways in which caregivers’ connections with their care recipient and others are shaped over time. Practice implications for health and social care practitioners who work with familial dementia caregivers are presented in light of the findings

The Subaru-XMM-Newton Deep Survey (SXDS) VIII.: Multi-wavelength Identification, Optical/NIR Spectroscopic Properties, and Photometric Redshifts of X-ray Sources

We report the multi-wavelength identification of the X-ray sources found in the Subaru-XMM-Newton Deep Survey (SXDS) using deep imaging data covering the wavelength range between the far-UV to the mid-IR. We select a primary counterpart of each X-ray source by applying the likelihood ratio method to R-band, 3.6micron, near-UV, and 24micron source catalogs as well as matching catalogs of AGN candidates selected in 1.4GHz radio and i'-band variability surveys. Once candidates of Galactic stars, ultra-luminous X-ray sources in a nearby galaxy, and clusters of galaxies are removed there are 896 AGN candidates in the sample. We conduct spectroscopic observations of the primary counterparts with multi-object spectrographs in the optical and NIR; 65\% of the X-ray AGN candidates are spectroscopically-identified. For the remaining X-ray AGN candidates, we evaluate their photometric redshift with photometric data in 15 bands. Utilising the multi-wavelength photometric data of the large sample of X-ray selected AGNs, we evaluate the stellar masses, M*, of the host galaxies of the narrow-line AGNs. The distribution of the stellar mass is remarkably constant from z=0.1 to 4.0. The relation between M* and 2--10 keV luminosity can be explained with strong cosmological evolution of the relationship between the black hole mass and M*. We also evaluate the scatter of the UV-MIR spectral energy distribution (SED) of the X-ray AGNs as a function of X-ray luminosity and absorption to the nucleus. The scatter is compared with galaxies which have redshift and stellar mass distribution matched with the X-ray AGN. The UV-NIR SEDs of obscured X-ray AGNs are similar to those of the galaxies in the matched sample. In the NIR-MIR range, the median SEDs of X-ray AGNs are redder, but the scatter of the SEDs of the X-ray AGN broadly overlaps that of the galaxies in the matched sample.Comment: Accepted for publication in PASJ Subaru special issue. 42 pages, 22 figures. Entire contents of Tables 3, 8, 9, 10, and 11, and ASCII format tables are available from http://www.astr.tohoku.ac.jp/~akiyama/SXDS/index.htm

Spectropolarimetry of the Type Ib Supernova iPTF 13bvn: revealing the complex explosion geometry of a stripped-envelope core-collapse supernova

We present six epochs of spectropolarimetric observations and one epoch of spectroscopy of the Type Ib SN iPTF 13bvn. The epochs of these observations correspond to −10 to +61 d with respect to the r-band light-curve maximum. The continuum is intrinsically polarized to the 0.2–0.4 per cent level throughout the observations, implying asphericities of ∼10 per cent in the shape of the photosphere. We observe significant line polarization associated with the spectral features of Ca II IR3, He I/Na I D, He I λλ6678, 7065, Fe II λ4924 and O I λ7774. We propose that an absorption feature at ∼6200 Å, usually identified as Si II λ6355, is most likely to be high-velocity H α at −16 400 km s−1. Two distinctly polarized components, separated in velocity, are detected for both He I/Na I D and Ca II IR3 , indicating the presence of two discrete line-forming regions in the ejecta in both radial velocity space and in the plane of the sky. We use the polarization of He I λ5876 as a tracer of sources of non-thermal excitation in the ejecta; finding that the bulk of the radioactive nickel was constrained to lie interior to ∼50–65 per cent of the ejecta radius. The observed polarization is also discussed in the context of the possible progenitor system of iPTF 13bvn, with our observations favouring the explosion of a star with an extended, distorted envelope rather than a compact Wolf–Rayet star

Real-Time Detection and Rapid Multiwavelength Follow-up Observations of a Highly Subluminous Type II-P Supernova from the Palomar Transient Factory Survey

The Palomar Transient Factory (PTF) is an optical wide-field variability survey carried out using a camera with a 7.8 square degree field of view mounted on the 48-in Oschin Schmidt telescope at Palomar Observatory. One of the key goals of this survey is to conduct high-cadence monitoring of the sky in order to detect optical transient sources shortly after they occur. Here, we describe the real-time capabilities of the PTF and our related rapid multiwavelength follow-up programs, extending from the radio to the gamma-ray bands. We present as a case study observations of the optical transient PTF10vdl (SN 2010id), revealed to be a very young core-collapse (Type II-P) supernova having a remarkably low luminosity. Our results demonstrate that the PTF now provides for optical transients the real-time discovery and rapid-response follow-up capabilities previously reserved only for high-energy transients like gamma-ray bursts.Comment: ApJ, in press; all spectroscopic data available from the Weizmann Institute of Science Experimental Astrophysics Spectroscopy System (WISEASS; http://www.weizmann.ac.il/astrophysics/wiseass/

PTF11eon/SN2011dh: Discovery of a Type IIb Supernova From a Compact Progenitor in the Nearby Galaxy M51

On May 31, 2011 UT a supernova (SN) exploded in the nearby galaxy M51 (the Whirlpool Galaxy). We discovered this event using small telescopes equipped with CCD cameras, as well as by the Palomar Transient Factory (PTF) survey, and rapidly confirmed it to be a Type II supernova. Our early light curve and spectroscopy indicates that PTF11eon resulted from the explosion of a relatively compact progenitor star as evidenced by the rapid shock-breakout cooling seen in the light curve, the relatively low temperature in early-time spectra and the prompt appearance of low-ionization spectral features. The spectra of PTF11eon are dominated by H lines out to day 10 after explosion, but initial signs of He appear to be present. Assuming that He lines continue to develop in the near future, this SN is likely a member of the cIIb (compact IIb; Chevalier and Soderberg 2010) class, with progenitor radius larger than that of SN 2008ax and smaller than the eIIb (extended IIb) SN 1993J progenitor. Our data imply that the object identified in pre-explosion Hubble Space Telescope images at the SN location is possibly a companion to the progenitor or a blended source, and not the progenitor star itself, as its radius (~10^13 cm) would be highly inconsistent with constraints from our post-explosion photometric and spectroscopic data