Engaging Health Professionals Toward the Redevelopment of a Continuing Competence Program

Continuing competence is the combination of knowledge, skills, abilities, and judgment of a professional, applied safely and ethically to their practice of the profession. Under the Health Professions Act in Alberta, health regulatory colleges must oversee the continuing competence of their registrants, ensuring they act in the public’s best interest. At Health Professionals Regulatory College (HPRC), over 3500 registrants are accountable to its continuing competence program (CCP). The current CCP, in place for over 15 years, has not integrated collection and analysis of diversity data that may influence individual competence, nor has it evolved with trends toward right-touch regulation that encourage data-informed, risk-based approaches to regulation. This organizational improvement plan (OIP) establishes the organizational context of HPRC within a structural-functional environment and applies critical theory to address the identified problem of practice (PoP)—the lack of a reflective and responsive CCP. A future CCP is envisioned to support ongoing practitioner learning, promote better practitioner-college relationships, increase confidence and status of the profession, and improve patient outcomes. Acknowledging that redevelopment of the CCP involves an emergent change process, the OIP focuses on rethinking the CCP as the first of three change cycles. Combined with an authentic leadership approach, appreciative inquiry is the selected change model to implement a strategy that balances top-down and bottom-up approaches, aiming to optimize stakeholder diversity and meaningful participation. Detailed plans for change implementation, communication, and monitoring and evaluation are outlined. The OIP concludes with thoughts on next steps for CCP redevelopment and future considerations for HPRC

Opportunities Galore! Growth Unlimited! Business, Higher Education Policy and the Neoliberalisation of Indian Higher Education

This thesis is about money in Indian Higher Education (HE) policy. More specifically, it is about describing the processes of neoliberalisation of the Indian Higher Education sector which reveals the prevalence of money and how education policy itself can serve as a profit opportunity for business. This thesis draws on Foucault’s concept of governmentality, understood as a means of steering and guiding the conduct of individuals, and deploys the approach of ‘following policy ’ and Social Network Analysis as its methodological and analytical tools to describe these processes of neoliberalisation. It identifies the key policy actors in Indian HE policy formulation, and describes how the socio-economic nature of their networks facilitate the flow of policy, ideas, practices, influence and money, within and between their multi-sited networks, and facilitate in reforming the Indian HE sector. The thesis illustrates how incremental policy moves which render and transform ideas into reformative imperatives, alongside the introduction of legislative measures and the creation of new institutions by the Government of India, serve to privilege and incentivise business to invest in the Indian HE sector. It demonstrates that the Government of India is an active - and necessary - facilitator of a form of network governance as it shifts the responsibility of Indian HE to business leaders and their networks, thereby situating the private sector - and the profit motive - centre stage of Indian HE policy, provision and delivery. It is intended that this analysis will contribute to the understanding of the vested interests in India’s HE sector while enabling an enhanced comprehension of the strategies that can promote, facilitate and advance policy reform alliances as India prepares to become a global player in HE

Effects of Electrical Stimulation on Wound Closure in Mice with Experimental Diabetes Mellitus

The purpose of the present study was to examine the effect of electrical stimulation (ES) on the closure of full-thickness excisional wounds in mice with type-1 experimental diabetes mellitus (DM). Alloxon monohydrate (100mg/kg) was used to induce experimental DM in mole CD-1 mice (n = 88). Full-thickness skin excisions (1cm2) in diabetic (urine glucose \u3e 0) and non-diabetic (urine glucose = 0) mice were administered 1, 3, or 5 treatments of ES (200μs, 200 Hz) for 15 minutes, at 0 (sham), 5, 10, or 12.5 volts. Alloxon injection resulted in a positive urine glucose test in 48 mice yielding an induction rate for DM of 54.5 percent. All groups exhibited decreases in wound length, perimeter, and surface area between days 2 and 16 following the creation of wounds. Non-diabetic wounds treated with ES hod the greatest percentage (60%) of closure. Diabetic wounds treated with ES hod a greater percentage of clo­sure (36%) compared with sham-treated diabetic animals (12.5%). Treatment of wounds with the highest voltage of ES (12.5V) produced significant (P \u3c 0.01) decreases in the surface area, and significant (P \u3c 0.01) changes in the shapes of wounds in both diabetic and non-diabetic animals compared with sham-treated animals. These results support the clinical use of this adjunctive therapy to accelerate the closure of ulcers due to OM

Investigating defects in monocyte responses to Mycobacterium tuberculosis in HIV-TB co-infection

Includes abstract. Includes bibliographical references

Patient Priorities Concerning Treatment Decisions for Advanced Neuroendocrine Tumors Identified by Discrete Choice Experiments.

BACKGROUND Patients with advanced neuroendocrine tumors (NETs) have multiple treatment options. Ideally, treatment decisions are shared between physician and patient; however, previous studies suggest that oncologists and patients place different value on treatment attributes such as adverse event (AE) rates. High-quality information on NET patient treatment preferences may facilitate patient-centered decision making by helping clinicians understand patient priorities. METHODS This study used 2 discrete choice experiments (DCE) to elicit preferences of NET patients regarding advanced midgut and pancreatic NET (pNET) treatments. The DCEs used the "potentially all pairwise rankings of all possible alternatives" (PAPRIKA) method. The primary objective was to determine relative utility rankings for treatment attributes, including progression-free survival (PFS), treatment modality, and AE rates. Ranking of attribute profiles matching specific treatments was also determined. Levels for treatment attributes were obtained from randomized clinical trial data of NET treatments. RESULTS One hundred and 10 participants completed the midgut NET DCE, and 132 completed the pNET DCE. Longer PFS was the highest ranked treatment attribute in 64.5% of participants in the midgut NET DCE, and in 59% in the pNET DCE. Approximately, 40% of participants in both scenarios prioritized lower AE rates or less invasive treatment modalities over PFS. Ranking of treatment profiles in the midgut NET scenario identified 60.9% of participants favoring peptide receptor radionuclide therapy (PRRT), and 30.0% somatostatin analogue dose escalation. CONCLUSION NET patients have heterogeneous priorities when choosing between treatment options based on the results of 2 independent DCEs. These results highlight the importance of shared decision making for NET patients

Enhancing HIV status disclosure and partners’ testing through counselling in Tanzania

Background: In Tanzania HIV Testing and Counselling (HTC) is being implemented through voluntary counselling and testing (VCT), provider initiated counselling and testing (PITC) and work place counselling and testing (HTC). Within these programmes, HIV status disclosure is emphasized. However, among persons who test HIV positive, many do not disclose their status to their partners and social networks.  However, data are lacking on the effectiveness of the different HTC strategies on HIV positive status disclosure.Objective: To investigate which of the three HIV Testing and Counselling (HTC) strategies: Voluntary Counselling and Testing (VCT), Provider Initiated Counselling and Testing (PITC) and work place Counselling and testing is associated with improved HIV-positive status disclosure in Eastern Tanzania.Methods: Structured interviews were conducted with 455 newly diagnosed HIV-positive clients at 6 HTC sites during enrolment and at three months follow-up to collect data on disclosure status.Results: We found that PITC strategy attended a relatively higher proportion of clients 182/455(40.1%) as compared to VCT 169/455 (37.1%) and work place HTC strategies 104/455(22.9%) respectively. Among clients, about one third 130/455(28.6%) were found to be HIV-positive. HIV status disclosure rates were variable and were in order of preference of disclosing to family members 86/130(66.2 %), followed by relatives 74/130(56.9%) and sexual partners 71/130(54.6%). A high proportion of participants 77/130(59.2%) experienced violence acts from sexual partners in form of stigma and discrimination, abuse, divorce and termination from employment. In the multivariate logistic regression, disclosure to sexual partners was associated with violence acts of about two times higher (Disclosure to Partners OR=1.89) when compared to the group that did not disclose to their partners.Conclusion: PITC strategy was found to result into higher rates of HIV positive status disclosure when compared to VCT and work place HTC strategies. Stigma, discrimination and violence acts are still prevalent in Tanzania and discourages HIV positive status disclosure. Based on these findings, there is an urgent need of promoting public education on HIV transmission, prevention and treatment and enhancing strategies to reduce risky sexual behaviour and increase condom use

A GA2LEN Study

Background: Flavonoids exert anti-inflammatory properties and modulate oxidative stress in vitro, suggesting a protective effect on lung function, but epidemiological studies examining this association are scarce. Methods: A stratified random sample was drawn from the GA2LEN screening survey, in which 55,000 adults aged 15 to 75 answered a questionnaire on respiratory symptoms. Post-bronchodilator spirometry was obtained from 2850 subjects. Forced vital capacity (FVC), the ratio between the forced exhaled volume in 1 second (FEV1) and FVC (FEV1/FVC), FVC below lower limit of normal (FVC < LLN), and FEV1/FVC < LLN were calculated. Intake of the six main subclasses of flavonoids was estimated using the GA2LEN Food Frequency Questionnaire. Adjusted associations between outcomes and each subclass of flavonoids were examined with multivariate regressions. Simes’ procedure was used to test for multiple comparisons. Results: A total of 2599 subjects had valid lung function and dietary data. A lower prevalence of FVC < LLN (airway restriction) was observed in those with higher total flavonoid (adjusted odds ratio (aOR), higher vs. lowest quintile intake 0.58; 95% Confidence Interval (CI) 0.36, 0.94), and pro-anthocyanidin intakes (aOR 0.47; 95% CI 0.27, 0.81). A higher FEV1/FVC was associated with higher intakes of total flavonoids and pro- anthocyanidins (adjusted correlation coefficient (a β-coeff 0.33; 0.10, 0.57 and a β-coeff 0.44; 95% CI 0.19, 0.69, respectively). After Simes’ procedure, the statistical significance of each of these associations was attenuated but remained below 0.05, with the exception of total flavonoids and airway restriction. Conclusions: This population-based study in European adults provides cross-sectional evidence of a positive association of total flavonoid intake and pro-anthocyanidins and ventilatory function, and a negative association with spirometric restriction in European adults. View Full-Tex

Differential detection and distribution of microglial and hematogenous macrophage populations in the injured spinal cord of lys-EGFP-ki transgenic mice

The acute inflammatory response that follows spinal cord injury (SCI) contributes to secondary injury that results in the expansion of the lesion and further loss of neurologic function. A cascade of receptor-mediated signaling events after SCI leads to activation of innate immune responses including the migration of microglia and active recruitment of circulating leukocytes. Because conventional techniques do not always distinguish macrophages derived from CNS-resident microglia from blood-derived monocytes, the role that each macrophage type performs cannot be assessed unambiguously in these processes. We demonstrate that, in the normal and spinal cord-injured lys-EGFP-ki transgenic mouse, enhanced green fluorescent protein (EGFP) is expressed only in mature hematopoietic granulomyelomonocytic cells and not in microglia. This allowed us to assess the temporal and spatial relationships between microglia-derived and hematogenous macrophages as well as neutrophils during a period of 6 weeks after clip compression SCI. Within the lesion, EGFP-positive monocyte-derived macrophages were found at the epicenter surrounded by EGFP-negative-activated microglia and microglia-derived macrophages. Neutrophils were not present when EGFP-positive monocyte-derived macrophages were depleted, indicating that neutrophil persistence in the lesion depended on the presence of these monocytes. Thus, these 2 distinct macrophage populations can be independently identified and tracked, thereby allowing their roles in acute and chronic stages of SCI-associated inflammation to be defined. Copyright © 2012 by the American Association of Neuropathologists, Inc

Sub-national tailoring of malaria interventions in Mainland Tanzania: simulation of the impact of strata-specific intervention combinations using modelling

BACKGROUND: To accelerate progress against malaria in high burden countries, a strategic reorientation of resources at the sub-national level is needed. This paper describes how mathematical modelling was used in mainland Tanzania to support the strategic revision that followed the mid-term review of the 2015-2020 national malaria strategic plan (NMSP) and the epidemiological risk stratification at the council level in 2018. METHODS: Intervention mixes, selected by the National Malaria Control Programme, were simulated for each malaria risk strata per council. Intervention mixes included combinations of insecticide-treated bed nets (ITN), indoor residual spraying, larval source management, and intermittent preventive therapies for school children (IPTsc). Effective case management was either based on estimates from the malaria indicator survey in 2016 or set to a hypothetical target of 85%. A previously calibrated mathematical model in OpenMalaria was used to compare intervention impact predictions for prevalence and incidence between 2016 and 2020, or 2022. RESULTS: For each malaria risk stratum four to ten intervention mixes were explored. In the low-risk and urban strata, the scenario without a ITN mass campaign in 2019, predicted high increase in prevalence by 2020 and 2022, while in the very-low strata the target prevalence of less than 1% was maintained at low pre-intervention transmission intensity and high case management. In the moderate and high strata, IPTsc in addition to existing vector control was predicted to reduce the incidence by an additional 15% and prevalence by 22%. In the high-risk strata, all interventions together reached a maximum reduction of 76%, with around 70% of that reduction attributable to high case management and ITNs. Overall, the simulated revised NMSP was predicted to achieve a slightly lower prevalence in 2020 compared to the 2015-2020 NMSP (5.3% vs 6.3%). CONCLUSION: Modelling supported the choice of intervention per malaria risk strata by providing impact comparisons of various alternative intervention mixes to address specific questions relevant to the country. The use of a council-calibrated model, that reproduces local malaria trends, represents a useful tool for compiling available evidence into a single analytical platform, that complement other evidence, to aid national programmes with decision-making processes

Spatio-temporal modelling of routine health facility data for malaria risk micro-stratification in mainland Tanzania

As malaria transmission declines, the need to monitor the heterogeneity of malaria risk at finer scales becomes critical to guide community-based targeted interventions. Although routine health facility (HF) data can provide epidemiological evidence at high spatial and temporal resolution, its incomplete nature of information can result in lower administrative units without empirical data. To overcome geographic sparsity of data and its representativeness, geo-spatial models can leverage routine information to predict risk in un-represented areas as well as estimate uncertainty of predictions. Here, a Bayesian spatio-temporal model was applied on malaria test positivity rate (TPR) data for the period 2017-2019 to predict risks at the ward level, the lowest decision-making unit in mainland Tanzania. To quantify the associated uncertainty, the probability of malaria TPR exceeding programmatic threshold was estimated. Results showed a marked spatial heterogeneity in malaria TPR across wards. 17.7 million people resided in areas where malaria TPR was high (>/= 30; 90% certainty) in the North-West and South-East parts of Tanzania. Approximately 11.7 million people lived in areas where malaria TPR was very low (< 5%; 90% certainty). HF data can be used to identify different epidemiological strata and guide malaria interventions at micro-planning units in Tanzania. These data, however, are imperfect in many settings in Africa and often require application of geo-spatial modelling techniques for estimation