An assessment of implementation of community - oriented primary care in Kenyan family medicine postgraduate medical education programmes

Background and objectives: Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC) curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya. Method: Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed. Results: Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1) making a community diagnosis, (2) understanding social determinants of health and (3) training in participatory research. Three community-based enablers for sustainability of COPC were (1) partnerships with community health workers, (2) community empowerment and engagement and (3) institutional financial support. Conclusions: Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya

Accurate reconstruction of insertion-deletion histories by statistical phylogenetics

The Multiple Sequence Alignment (MSA) is a computational abstraction that represents a partial summary either of indel history, or of structural similarity. Taking the former view (indel history), it is possible to use formal automata theory to generalize the phylogenetic likelihood framework for finite substitution models (Dayhoff's probability matrices and Felsenstein's pruning algorithm) to arbitrary-length sequences. In this paper, we report results of a simulation-based benchmark of several methods for reconstruction of indel history. The methods tested include a relatively new algorithm for statistical marginalization of MSAs that sums over a stochastically-sampled ensemble of the most probable evolutionary histories. For mammalian evolutionary parameters on several different trees, the single most likely history sampled by our algorithm appears less biased than histories reconstructed by other MSA methods. The algorithm can also be used for alignment-free inference, where the MSA is explicitly summed out of the analysis. As an illustration of our method, we discuss reconstruction of the evolutionary histories of human protein-coding genes.Comment: 28 pages, 15 figures. arXiv admin note: text overlap with arXiv:1103.434

Crop Updates 2006 - Oilseeds

This session covers thirteen papers from different authors: 1. INTRODUCTION, Graham Walton, CONVENOR, Department of Agriculture 2. The performance of new TT canola varieties in National Variety Testing (NVT) WA, Fiona Martin, Research Agronomist, Agritech Crop Research 3. Comparison of TT Canola Varieties in Oilseeds WA Trials – 2005, Collated by G.H. Walton, Department of Agriculture, WA, from a collaboration between Oilseeds WA, Seed Companies, Agronomists and Growers 4. An overview of the potential for a Biofuels Industry in Western Australia, Anne Wilkins and Nathan Hancock, Department of Agriculture 5. Retrieval of fertile progeny from interspecific crosses between Brassica napus and B. carinata using microspore culture, Matthew Nelson, Marie-Claire Castello, Linda Thomson, Anouska Cousin, Guijun Yan and Wallace Cowling; School of Plant Biology (M084), The University of Western Australia 6. Advances in canola blackleg epidemiology and its implication in understanding and managing the disease, Moin Salam, Bill MacLeod, Ravjit Khangura, Jean Galloway and Art Diggle, Department of Agriculture 7. Effect of fertiliser phosphorus and nitrogen on grain yields and concentration of oil and protein of canola grain, R.F. Brennan, M.D.A. Bolland, Department of Agriculture 8. Effect of applying fertiliser potassium and nitrogen on canola grain yields and concentration of oil and protein in grain, R.F. Brennan, M.D.A. Bolland, Department of Agriculture 9. Effect of fertiliser nitrogen and sulfer on canola yields and concentration of oil in grain, R.F. Brennan, M.D.A. Bolland, Department of Agriculture 10. Uptake of K from topsoil and subsoil by canola, P.M. Damon and Z. Rengel, Faculty of Natural and Agricultural Sciences, The University of WA 11. Accumulation of P and K by canola plants, Terry Rose, Zed Rengel and Qifu Ma, Faculty of Natural and Agricultural Sciences, The University of WA 12. Varied response from applying nitrogen at late flowering in canola! Dave Eksteen, Agronomist, United Farmers Cooperative 13. To investigate the timing, rate and placement of nitrogen on canola – Jerdacuttup 2005, Dave Eksteen, Agronomist, United Farmers Cooperativ

Reading the Bible in the 21st century: Some hermeneutical principles: Part 1

Many books and articles have been published over several decades on ‘biblical hermeneutics’ to capture the epistemology of biblical hermeneutics and the phenomenology of interpretation, communication and language in order to direct the Bible reader how to read the ancient texts, assembled in the Bible, sensibly. The first part of this essay looks briefly into the history of biblical hermeneutics of the past century in order to generate an orientation of how ‘biblical hermeneutics’ was regarded and applied as well as to constitute an environment for the investigation to follow in the rest of this essay and in a succeeding essay. In the second part of this essay, a few hermeneutical approaches are analysed in order to recommend a way forward for the dynamic analysis and interpretation (ἑρμηνεία) of biblical texts. This prepares the stage for the recommendation of two extra textures or aspects to be incorporated in the hermeneutical process, to be investigated in a succeeding essay.Christian Spirituality, Church History and Missiolog

Improving the evidence base of Markov models used to estimate the costs of scaling up antiretroviral programmes in resource-limited settings

<p>Abstract</p> <p>Background</p> <p>Despite concerns about affordability and sustainability, many models of the lifetime costs of antiretroviral therapy (ART) used in resource limited settings are based on data from small research cohorts, together with pragmatic assumptions about life-expectancy. This paper revisits these modelling assumptions in order to provide input to future attempts to model the lifetime costs and the costs of scaling up ART.</p> <p>Methods</p> <p>We analysed the determinants of costs and outcomes in patients receiving ART in line with standard World Health Organization (WHO) guidelines for resource poor settings in a private sector managed ART programme in South Africa. The cohort included over 5,000 patients with up to 4 years (median 19 months) on ART. Generalized linear and Cox proportional hazards regression models were used to establish cost and outcome determinants respectively.</p> <p>Results</p> <p>The key variables associated with changes in mean monthly costs were: being on the second line regimen; receiving ART from 4 months prior to 4 months post treatment initiation; having a recent or current CD4 count <50 cells/µL or 50-199 cells/µl; having mean ART adherence <75% as determined by monthly pharmacy refill data; and having a current or recent viral load >100,000 copies/mL. In terms of the likelihood of dying, the key variables were: baseline CD4 count<50 cells/µl (particularly during the first 4 months on treatment); current CD4 count <50 cells/µl and 50-199 cells/µl (particularly during later periods on treatment); and being on the second line regimen. Being poorly adherent and having an unsuppressed viral load was also associated with a higher likelihood of dying.</p> <p>Conclusions</p> <p>While there are many unknowns associated with modelling the resources needed to scale-up ART, our analysis has suggested a number of key variables which can be used to improve the state of the art of modelling ART. While the magnitude of the effects associated with these variables would be likely to differ in other settings, the variables influencing costs and survival are likely to be generalizable. This is of direct relevance to those concerned about assessing the long-term costs and sustainability of expanded access to ART.</p

University of Oregon Department of Art MFA

34 pagesThe Department of Art at the University of Oregon is pleased to present our 2019 MFA Thesis Exhibition at Disjecta Contemporary Art Center in Portland, Oregon. Marking the culmination of three years of rigorous studio investigation and critical discourse, the ten artists in this exhibition engage a wide breadth of art making practices that build on and challenge the histories of painting, sculpture, photography, print media, craft and digital practices. The exhibition is the outcome of the expansive work undertaken by our graduates and their intellectual curiosity in looking deeply at the conditions prevalent and pressing in our world today. With dramatic shifts in practice over the past three years, this cohort of artists have created a tight-knit community through the exchange of ideas formed by extensive conversations with our nationally and internationally recognized faculty, visiting artists, critics and curators. For this catalog, we bring our MFA Graduates together with the PHD and MA students in the History of Art and Architecture Department to produce written reflections on the creative processes and concepts behind the works of our ten graduating artists. This collaborative initiative, made possible through the stellar organization of Professor Jenny Lin, highlights what we hope to accomplish in our academic and artistic life – gather together around contexts that matter and build connections that expand our subject positions. So, it is with great pride that we celebrate the final work created by our 2019 MFA graduates at the University of Oregon and we look forward to watching and cheering their creative endeavors yet to come

Characterization and Comparison of the Tissue-Related Modules in Human and Mouse

BACKGROUND: Due to the advances of high throughput technology and data-collection approaches, we are now in an unprecedented position to understand the evolution of organisms. Great efforts have characterized many individual genes responsible for the interspecies divergence, yet little is known about the genome-wide divergence at a higher level. Modules, serving as the building blocks and operational units of biological systems, provide more information than individual genes. Hence, the comparative analysis between species at the module level would shed more light on the mechanisms underlying the evolution of organisms than the traditional comparative genomics approaches. RESULTS: We systematically identified the tissue-related modules using the iterative signature algorithm (ISA), and we detected 52 and 65 modules in the human and mouse genomes, respectively. The gene expression patterns indicate that all of these predicted modules have a high possibility of serving as real biological modules. In addition, we defined a novel quantity, "total constraint intensity," a proxy of multiple constraints (of co-regulated genes and tissues where the co-regulation occurs) on the evolution of genes in module context. We demonstrate that the evolutionary rate of a gene is negatively correlated with its total constraint intensity. Furthermore, there are modules coding the same essential biological processes, while their gene contents have diverged extensively between human and mouse. CONCLUSIONS: Our results suggest that unlike the composition of module, which exhibits a great difference between human and mouse, the functional organization of the corresponding modules may evolve in a more conservative manner. Most importantly, our findings imply that similar biological processes can be carried out by different sets of genes from human and mouse, therefore, the functional data of individual genes from mouse may not apply to human in certain occasions

Factors associated with paradoxical immune response to antiretroviral therapy in HIV infected patients: a case control study

<p>Abstract</p> <p>Background</p> <p>A paradoxical immunologic response (PIR) to Highly Active Antiretroviral Therapy (HAART), defined as viral suppression without CD4 cell-count improvement, has been reported in the literature as 8 to 42%, around 15% in most instances. The present study aims to determine, in a cohort of HIV infected patients in Brazil, what factors were independently associated with such a discordant response to HAART.</p> <p>Methods</p> <p>A case-control study (1:4) matched by gender was conducted among 934 HIV infected patients on HAART in Brazil. Cases: patients with PIR, defined as CD4 < 350 cells/mm³(hazard ratio for AIDS or death of at least 8.5) and undetectable HIV viral load on HAART for at least one year. Controls: similar to cases, but with CD4 counts ≥ 350 cells/mm³. Eligibility criteria were applied. Data were collected from medical records using a standardized form. Variables were introduced in a hierarchical logistic regression model if a p-value < 0.1 was determined in a bivariate analysis.</p> <p>Results</p> <p>Among 934 patients, 39 cases and 160 controls were consecutively selected. Factors associated with PIR in the logistic regression model were: total time in use of HAART (OR 0.981; CI 95%: 0.96-0.99), nadir CD4-count (OR 0.985; CI 95%: 0.97-0.99), and time of undetectable HIV viral load (OR 0.969; CI 95%: 0.94-0.99).</p> <p>Conclusions</p> <p>PIR seems to be related to a delay in the management of immunodeficient patients, as shown by its negative association with nadir CD4-count. Strategies should be implemented to avoid such a delay and improve the adherence to HAART as a way to implement concordant responses.</p

HIV-1 Nef Protein Structures Associated with Brain Infection and Dementia Pathogenesis

The difference between regional rates of HIV-associated dementia (HAD) in patients infected with different subtypes of HIV suggests that genetic determinants exist within HIV that influence the ability of the virus to replicate in the central nervous system (in Uganda, Africa, subtype D HAD rate is 89%, while subtype A HAD rate is 24%). HIV-1 nef is a multifunctional protein with known toxic effects in the brain compartment. The goal of the current study was to identify if specific three-dimensional nef structures may be linked to patients who developed HAD. HIV-1 nef structures were computationally derived for consensus brain and non-brain sequences from a panel of patients infected with subtype B who died due to varied disease pathologies and consensus subtype A and subtype D sequences from Uganda. Site directed mutation analysis identified signatures in brain structures that appear to change binding potentials and could affect folding conformations of brain-associated structures. Despite the large sequence variation between HIV subtypes, structural alignments confirmed that viral structures derived from patients with HAD were more similar to subtype D structures than to structures derived from patient sequences without HAD. Furthermore, structures derived from brain sequences of patients with HAD were more similar to subtype D structures than they were to their own non-brain structures. The potential finding of a brain-specific nef structure indicates that HAD may result from genetic alterations that alter the folding or binding potential of the protein

Comprehensive inventory of true flies (Diptera) at a tropical site

Peer reviewe