Development of a technical assistance framework for building organizational capacity of health programs in resource-limited settings

Background Little information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR). This paper describes the methods used to adapt the Primary Care Assessment Tool (PCAT) framework, which has successfully strengthened HIV primary care services in the US, into one that could strengthen the capacity of local partners to deliver priority health programs in resource-constrained settings by identifying their specific technical assistance needs. Methods Qualitative methods and inductive reasoning approaches were used to conceptualize and adapt the new Clinical Assessment for Systems Strengthening (ClASS) framework. Stakeholder interviews, comparisons of existing assessment tools, and a pilot test helped determine the overall ClASS framework for use in low-resource settings. The framework was further refined one year post-ClASS implementation. Results Stakeholder interviews, assessment of existing tools, a pilot process and the one-year post- implementation assessment informed the adaptation of the ClASS framework for assessing and strengthening technical and managerial capacities of health programs at three levels: international partner, local indigenous partner, and local partner treatment facility. The PCAT focus on organizational strengths and systems strengthening was retained and implemented in the ClASS framework and approach. A modular format was chosen to allow the use of administrative, fiscal and clinical modules in any combination and to insert new modules as needed by programs. The pilot led to refined pre-visit planning, informed review team composition, increased visit duration, and restructured modules. A web-based toolkit was developed to capture three years of experiential learning; this kit can also be used for independent implementation of the ClASS framework. Conclusions A systematic adaptation process has produced a qualitative framework that can inform implementation strategies in support of country led HIV care and treatment programs. The framework, as a well-received iterative process focused on technical assistance, may have broader utility in other global programs

Simulation-based education within respiratory physiotherapy training:a scoping review

Objective The aim of this scoping review is to provide respiratory physiotherapists with guidance on the implementation of simulation-based education Introduction In recent years there has been a widespread rise in the adoption of simulation-based education. A scoping review was decided upon by the ACPRC Editorial Board to focus on any new evidence or guidance in the field. Inclusion criteria 1) Studies investigating the use of simulation-based education within respiratory physiotherapy 2) Meta-analyses, systematic reviews, scoping reviews, randomised controlled trials and observational studies. Methods A literature search was developed and refined through testing. Nine databases were searched between 01/01/2014 and 31/10/2022. Data regarding study design, population, intervention, comparator and control were extracted into a data extraction table. Results were grouped by study design, intervention or context. Results 141 sources were retrieved from the searches. After initial screening 27 sources were included and after full-text review, 25 were included. Sources included: meta-analyses and systematic review and studies considering pre-registration education, interprofessional learning, part-task trainers and postgraduate education. Conclusion There is increasing research output in the simulation-based education field for respiratory physiotherapy. The evidence continues to focus on learner experience. More resources and support are required to increase access to simulation-based education for respiratory physiotherapists

Who Underreports Smoking on Birth Records: A Monte Carlo Predictive Model with Validation

Research has shown that self-reports of smoking during pregnancy may underestimate true prevalence. However, little is known about which populations have higher rates of underreporting. Availability of more accurate measures of smoking during pregnancy could greatly enhance the usefulness of existing studies on the effects of maternal smoking offspring, especially in those populations where underreporting may lead to underestimation of the impact of smoking during pregnancy.In this paper, we develop a statistical Monte Carlo model to estimate patterns of underreporting of smoking during pregnancy, and apply it to analyze the smoking self-report data from birth certificates in the state of Massachusetts. Our results illustrate non-uniform patterns of underreporting of smoking during pregnancy among different populations. Estimates of likely underreporting of smoking during pregnancy were highest among mothers who were college-educated, married, aged 30 years or older, employed full-time, and planning to breastfeed. The model's findings are validated and compared to an existing underreporting adjustment approach in the Maternal and Infant Smoking Study of East Boston (MISSEB).The validation results show that when biological assays are not available, the Monte Carlo method proposed can provide a more accurate estimate of the smoking status during pregnancy than self-reports alone. Such methods hold promise for providing a better assessment of the impact of smoking during pregnancy

What young people want from health-related online resources: a focus group study

The growth of the Internet as an information source about health, particularly amongst young people, is well established. The aim of this study was to explore young people's perceptions and experiences of engaging with health-related online content, particularly through social media websites. Between February and July 2011 nine focus groups were facilitated across Scotland with young people aged between 14 and 18 years. Health-related user-generated content seems to be appreciated by young people as a useful, if not always trustworthy, source of accounts of other people's experiences. The reliability and quality of both user-generated content and official factual content about health appear to be concerns for young people, and they employ specialised strategies for negotiating both areas of the online environment. Young people's engagement with health online is a dynamic area for research. Their perceptions and experiences of health-related content seem based on their wider familiarity with the online environment and, as the online environment develops, so too do young people's strategies and conventions for accessing it

Measuring Basal Force Fluctuations of Debris Flows Using Seismic Recordings and Empirical Green's Functions

We present a novel method for measuring the fluctuating basal normal and shear stresses of debris flows by using along‐channel seismic recordings. Our method couples a simple parameterization of a debris flow as a seismic source with direct measurements of seismic path effects using empirical Green's functions generated with a force hammer. We test this method using two large‐scale (8 and 10 m³) experimental flows at the U.S. Geological Survey debris‐flow flume that were recorded by dozens of three‐component seismic sensors. The seismically derived basal stress fluctuations compare well in amplitude and timing to independent force plate measurements within the valid frequency range (15–50 Hz). We show that although the high‐frequency seismic signals provide band‐limited forcing information, there are systematic relations between the fluctuating stresses and independently measured flow properties, especially mean basal shear stress and flow thickness. However, none of the relationships are simple, and since the flow properties also correlate with one another, we cannot isolate a single factor that relates in a simple way to the fluctuating forces. Nevertheless, our observations, most notably the gradually declining ratio of fluctuating to mean basal stresses during flow passage and the distinctive behavior of the coarse, unsaturated flow front, imply that flow style may be a primary control on the conversion of translational to vibrational kinetic energy. This conversion ultimately controls the radiation of high‐frequency seismic waves. Thus, flow style may provide the key to revealing the nature of the relationship between fluctuating forces and other flow properties

Measuring Basal Force Fluctuations of Debris Flows Using Seismic Recordings and Empirical Green's Functions

We present a novel method for measuring the fluctuating basal normal and shear stresses of debris flows by using along‐channel seismic recordings. Our method couples a simple parameterization of a debris flow as a seismic source with direct measurements of seismic path effects using empirical Green's functions generated with a force hammer. We test this method using two large‐scale (8 and 10 m³) experimental flows at the U.S. Geological Survey debris‐flow flume that were recorded by dozens of three‐component seismic sensors. The seismically derived basal stress fluctuations compare well in amplitude and timing to independent force plate measurements within the valid frequency range (15–50 Hz). We show that although the high‐frequency seismic signals provide band‐limited forcing information, there are systematic relations between the fluctuating stresses and independently measured flow properties, especially mean basal shear stress and flow thickness. However, none of the relationships are simple, and since the flow properties also correlate with one another, we cannot isolate a single factor that relates in a simple way to the fluctuating forces. Nevertheless, our observations, most notably the gradually declining ratio of fluctuating to mean basal stresses during flow passage and the distinctive behavior of the coarse, unsaturated flow front, imply that flow style may be a primary control on the conversion of translational to vibrational kinetic energy. This conversion ultimately controls the radiation of high‐frequency seismic waves. Thus, flow style may provide the key to revealing the nature of the relationship between fluctuating forces and other flow properties

The chemical evolution of the solar neighbourhood for planet-hosting stars

Theoretical physical-chemical models for the formation of planetary systems depend on data quality for the Sun's composition, that of stars in the solar neighbourhood, and of the estimated "pristine" compositions for stellar systems. The effective scatter and the observational uncertainties of elements within a few hundred parsecs from the Sun, even for the most abundant metals like carbon, oxygen and silicon, are still controversial. Here we analyse the stellar production and the chemical evolution of key elements that underpin the formation of rocky (C, O, Mg, Si) and gas/ice giant planets (C, N, O, S). We calculate 198 galactic chemical evolution (GCE) models of the solar neighbourhood to analyse the impact of different sets of stellar yields, of the upper mass limit for massive stars contributing to GCE ($M_{\rm up}$) and of supernovae from massive-star progenitors which do not eject the bulk of the iron-peak elements (faint supernovae). Even considering the GCE variation produced via different sets of stellar yields, the observed dispersion of elements reported for stars in the Milky Way disk is not reproduced. Among others, the observed range of super-solar [Mg/Si] ratios, sub-solar [S/N], and the dispersion of up to 0.5 dex for [S/Si] challenge our models. The impact of varying $M_{\rm up}$ depends on the adopted supernova yields. Thus, observations do not provide a constraint on the M$_{\rm up}$ parametrization. When including the impact of faint supernova models in GCE calculations, elemental ratios vary by up to 0.1-0.2 dex in the Milky Way disk; this modification better reproduces observations.Comment: 36 pages, 26 figures, 1 Table, 1 Appendix, Accepted for publication in MNRA

The effect of a startle-eliciting device on the foraging success of individual harbor seals (Phoca vitulina)

Pinniped predation on commercially and ecologically important prey has been a source of conflict for centuries. In the Salish Sea, harbor seals (Phoca vitulina) are suspected of impeding the recovery of culturally and ecologically critical Pacific salmon (Oncorhynchus spp.). In Fall 2020, a novel deterrent called Targeted Acoustic Startle Technology (TAST) was deployed at Whatcom Creek to deter harbor seals from preying on fall runs of hatchery chum (O. keta) and Chinook (O. tshawytscha) salmon in Bellingham, Washington, USA. Field observations were conducted in 2020 to compare the presence and foraging success of individual harbor seals across sound exposure (TAST-on) and control (TAST-off) conditions. Observations conducted the previous (2019) and following (2021) years were used to compare the effects observed in 2020 to two control years. Using photo-identification, individual seals were associated with foraging successes across all 3 years of the study. Generalized linear mixed models showed a significant 45.6% reduction in the duration (min) individuals remained at the creek with TAST on, and a significant 43.8% reduction in the overall foraging success of individuals. However, the observed effect of TAST varied across individual seals. Seals that were observed regularly within one season were more likely to return the year after, regardless of TAST treatment. Generalized linear models showed interannual variation in the number of seals present and salmon consumed. However, the effect of TAST in 2020 was greater than the observed variation across years. Our analyses suggest TAST can be an effective tool for managing pinniped predation, although alternate strategies such as deploying TAST longer-term and using multi-unit setups to increase coverage could help strengthen its effects. Future studies should further examine the individual variability found in this study.Peer reviewe