256 research outputs found

    Produire un rapport d\u27activité : Pourquoi ? Comment ?

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    Mémoire de fin d\u27étude du diplôme de conservateur, promotion 24, portant sur les rapports d\u27activité produits par les bibliothèques françaises

    Reference to index of Thomas Hodgkin - Visit to Australia 1909: account of the visit and photograph album

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    Dr Thomas Hodgkin of Barmoor Castle, Beal, Northumberland, U.K, made a religious visit to members of the Society of Friends (Quakers) in Australia, Tasmania and New Zealand in 1909, accompanied by his wife, eldest daughter, Violet, and youngest son, George. Violet Hodgkin wrote an account of the visit, describing her impressions of colonial life (not always favourable), the meetings and social functions and detailed descriptions of the chief Friends' in each place. In Hobart, where they arrived on 9 March 1909, after brief calls at Perth and Melbourne, and stayed at Heathorn's Hotel, Violet described especially the Mathers, the Robeys and their daughters Linor and Margie, the Propstings whose shop "was not doing well", Edith Barnett, John Ridley Walker, Elder of the Meeting and his aunt Mary Augusta Walker. Violet Hodgkin and her brother held special meetings, talks or Bible classes for the younger members in each place and in Sydney, Helbourne and Adelaide joined the Young Friends camps. In Hobart Violet describes several girls from Friends High School. Hobart, New Zealand and Adelaide were highlights of the visit. Violet Hodgkin does not say much about Sydney, where they spent 2 months, except for a visit to the AlIens in the Blue Mountains, and the visits Queensland and Melbourne were short and often difficult. Some photos of groups and people met are stuck in the diary account, but there is also a photograph album of people met, groups and scenery

    Lay perceptions of breast cancer in Western Kenya

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    AIM: To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cancer. METHODS: In October-November 2012, we recruited men and women (18 years and older) from households and health facilities in three different parts of Western Kenya, chosen for variations in their documented burdens of breast cancer. A standardized and validated tool, the breast cancer awareness measure (BCAM), was administered in face-to-face interviews. Survey domains covered included socio-demographics, opinions about causes, symptoms, severity, and treatment of breast cancer. Descriptive analyses were done on quantitative data while open-ended answers were coded, and emerging themes were integrated into larger categories in a qualitative analysis. The open-ended questions had been added to the standard BCAM for the purposes of learning as much as the investigators could about underlying lay beliefs and perceptions. RESULTS: Most respondents were female, middle-aged (mean age 36.9 years), married, and poorly educated. Misconceptions and lack of knowledge about causes of breast cancer were reported. The following (in order of higher to lower prevalence) were cited as potential causes of the condition: Genetic factors or heredity (n = 193, 12.3%); types of food consumed (n = 187, 11.9%); witchcraft and curses (n = 108, 6.9%); some family planning methods (n = 56, 3.6%); and use of alcohol and tobacco (n = 46, 2.9%). When asked what they thought of breast cancer’s severity, the most popular response was “it is a killer disease” (n = 266, 19.7%) a lethal condition about which little or nothing can be done. While opinions about presenting symptoms and signs of breast cancer were able to be elicited, such as an increase in breast size and painful breasts, early-stage symptoms and signs were not widely recognized. Some respondents (14%) were ignorant of available treatment altogether while others felt breast cancer treatment is both dangerous and expensive. A minority reported alternative medicine as providing relief to patients. CONCLUSION: The impoverished knowledge in these surveys suggests that lay education as well as better screening and treatment should be part of breast cancer control in Kenya

    Factors Affecting the Spatial Distribution of Black Mangrove on the Dredged-Material or “Spoil” Islands in the Lower Laguna Madre of Texas

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    Research was conducted to evaluate the spatial distribution of black mangrove (Avicennia germinans) on the dredged-material or “spoil” islands of the Lower Laguna Madre of Texas. Aerial color-infrared (CIR) photographs revealed the presence of black mangrove stands on many of the islands located south of the Arroyo Colorado (a distributary of the Rio Grande which empties into the Laguna Madre), but failed to detect significant mangrove stands on islands located north of the Arroyo. Analysis of CIR photographs and supervised image classifications for individual islands suggested a concentration of black mangrove along western shorelines and relatively low interior areas of islands, although relatively small and localized mangrove stands were clearly evident along eastern shorelines at several locations. These observations were consistent with ground surveys which indicated significantly higher mangrove densities along western vs eastern shorelines of selected islands (0.6 and 0.1 plants/m2, respectively; P \u3c 0.05), but no difference between ratios of small to large plants in stands located along western vs eastern shorelines (1.6 and 1.4, respectively; P\u3e0.05). The most plausible explanation for these trends is that wave action caused by prevailing southeasterly winds during most of the year may impede or prevent the establishment of black mangrove propagules (germinated „seeds‟) along eastern shorelines of islands which otherwise constitute suitable habitat for A. germinans. If this interpretation is correct, development of planting strategies designed to facilitate establishment of black mangrove stands along shorelines subject to turbulent wave action will be a requisite to the use of this important native plant species for erosion prevention and mitigation on spoil islands in the Lower Laguna Madre

    Barriers and Facilitators to Nurse Management of Hypertension: A Qualitative Analysis from Western Kenya

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    BACKGROUND: Hypertension is the leading global risk for mortality. Poor treatment and control of hypertension in low- and middle-income countries is due to several reasons, including insufficient human resources. Nurse management of hypertension is a novel approach to address the human resource challenge. However, specific barriers and facilitators to this strategy are not known. OBJECTIVE: To evaluate barriers and facilitators to nurse management of hypertensive patients in rural western Kenya, using a qualitative research approach. METHODS: Six key informant interviews (five men, one woman) and seven focus group discussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses, support staff, patients, and community leaders. Content analysis was performed using Atlas.ti 7.0, using deductive and inductive codes that were then grouped into themes representing barriers and facilitators. Ranking of barriers and facilitators was performed using triangulation of density of participant responses from the focus group discussions and key informant interviews, as well as investigator assessments using a two-round Delphi exercise. RESULTS: We identified a total of 23 barriers and nine facilitators to nurse management of hypertension, spanning the following categories of factors: health systems, environmental, nurse-specific, patient-specific, emotional, and community. The Delphi results were generally consistent with the findings from the content analysis. CONCLUSION: Nurse management of hypertension is a potentially feasible strategy to address the human resource challenge of hypertension control in low-resource settings. However, successful implementation will be contingent upon addressing barriers such as access to medications, quality of care, training of nurses, health education, and stigma

    Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) in western Kenya: a study protocol of a cluster randomized trial

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    BACKGROUND: Hypertension is a major risk factor for cardiovascular disease (CVD), yet treatment and control rates for hypertension are very low in low- and middle-income countries (LMICs). Lack of effective referral networks between different levels of the health system is one factor that threatens the ability to achieve adequate blood pressure control and prevent CVD-related morbidity. Health information technology and peer support are two strategies that have improved care coordination and clinical outcomes for other disease entities in other settings; however, their effectiveness and cost-effectiveness in strengthening referral networks to improve blood pressure control and reduce CVD risk in low-resource settings are unknown. METHODS/DESIGN: We will use the PRECEDE-PROCEED framework to conduct transdisciplinary implementation research, focused on strengthening referral networks for hypertension in western Kenya. We will conduct a baseline needs and contextual assessment using a mixed-methods approach, in order to inform a participatory, community-based design process to fully develop a contextually and culturally appropriate intervention model that combines health information technology and peer support. Subsequently, we will conduct a two-arm cluster randomized trial comparing 1) usual care for referrals vs 2) referral networks strengthened with our intervention. The primary outcome will be one-year change in systolic blood pressure. The key secondary clinical outcome will be CVD risk reduction, and the key secondary implementation outcomes will include referral process metrics such as referral appropriateness and completion rates. We will conduct a mediation analysis to evaluate the influence of changes in referral network characteristics on intervention outcomes, a moderation analysis to evaluate the influence of baseline referral network characteristics on the effectiveness of the intervention, as well as a process evaluation using the Saunders framework. Finally, we will analyze the incremental cost-effectiveness of the intervention relative to usual care, in terms of costs per unit decrease in systolic blood pressure, per percentage change in CVD risk score, and per disability-adjusted life year saved. DISCUSSION: This study will provide evidence for the implementation of innovative strategies for strengthening referral networks to improve hypertension control in LMICs. If effective, it has the potential to be a scalable model for health systems strengthening in other low-resource settings worldwide

    Cardiac prehabilitation, rehabilitation and education in first-time atrial fibrillation (AF) ablation (CREED AF):Study protocol for a randomised controlled trial

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    Background: Atrial fibrillation (AF) is associated with significant morbidity/mortality. AF-ablation is an increasingly used treatment. Currently, first-time AF-ablation success is 40–80% at 1-year, depending on individual factors. There is growing evidence for improved outcomes through management of AF risk-factors/comorbidities via patient education/exercise-rehabilitation. There are no studies assessing combined prehabilitation/rehabilitation in this cohort. The aim of this randomised controlled trial is to assess efficacy of comprehensive prehabilitation/ rehabilitation and combining supervised exercise-training with AF risk-factor modification/ education compared with standard care in people undergoing first-time AF ablation. Methods: This single-centre pragmatic randomised controlled trial will recruit 106 adults with paroxysmal/persistent AF listed for first-time AF-ablation. Participants will be randomised 1:1 to cardiac prehabilitation/rehabilitation/education (CREED AF) intervention or standard care. Both groups will undergo AF-ablation at 8-weeks post-randomisation as per usual care. The CREED AF intervention will involve 6-weeks of prehabilitation (before AF-ablation) followed by 6-weeks rehabilitation (after AF-ablation) consisting of risk factor education/modification and supervised exercise training. Standard care will include a single 30-minute session of risk-factor education. Outcomes will be measured at baseline, 10-weeks and 12-months post AF-ablation, by researchers blinded to treatment allocation. The primary outcome is cardiorespiratory-fitness (peak oxygen uptake, VO 2peak) assessed using cardiopulmonary exercise testing (CPET) at 10-weeks post-ablation. Secondary outcomes include health-related quality of life, AF recurrence/burden assessed by 7-day Holter-monitor, requirement for repeat AF-ablation, study defined major adverse cardiovascular events, and cost-effectiveness (incremental cost per quality-adjusted life year (QALY)). Conclusions: This study will assess clinical-efficacy/cost-effectiveness of comprehensive prehabilitation/ rehabilitation/patient-education for people undergoing first time AF-ablation. Results will inform clinical care and design of future multi-centre clinical trials.</p

    Assessment of algorithms for mitosis detection in breast cancer histopathology images

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    The proliferative activity of breast tumors, which is routinely estimated by counting of mitotic figures in hematoxylin and eosin stained histology sections, is considered to be one of the most important prognostic markers. However, mitosis counting is laborious, subjective and may suffer from low inter-observer agreement. With the wider acceptance of whole slide images in pathology labs, automatic image analysis has been proposed as a potential solution for these issues. In this paper, the results from the Assessment of Mitosis Detection Algorithms 2013 (AMIDA13) challenge are described. The challenge was based on a data set consisting of 12 training and 11 testing subjects, with more than one thousand annotated mitotic figures by multiple observers. Short descriptions and results from the evaluation of eleven methods are presented. The top performing method has an error rate that is comparable to the inter-observer agreement among pathologists

    Street-Level Diplomacy and Local Enforcement for Meat Safety in Northern Tanzania: Kowledge, Pragmatism and Trust

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    With increasing demand for red meat in Tanzania comes heightened potential for zoonotic infections in animals and humans that disproportionately affect poor communities. A range of frontline government employees work to protect public health, providing services for people engaged in animal-based livelihoods (livestock owners and butchers), and enforcing meat safety and food premises standards. In contrast to literature which emphasises the inadequacy of extension support and food safety policy implementation in low- and middle-income countries, this paper foregrounds the ‘street-level diplomacy’ deployed by frontline actors operating in challenging contexts
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