Considerations for preparing a randomized population health intervention trial: lessons from a South African–Canadian partnership to improve the health of health workers

Background: Community-based cluster-randomized controlled trials (RCTs) are increasingly being conducted to address pressing global health concerns. Preparations for clinical trials are well-described, as are the steps for multi-component health service trials. However, guidance is lacking for addressing the ethical and logistic challenges in (cluster) RCTs of population health interventions in low- and middle-income countries. Objective: We aimed to identify the factors that population health researchers must explicitly consider when planning RCTs within North–South partnerships. Design: We reviewed our experiences and identified key ethical and logistic issues encountered during the pre-trial phase of a recently implemented RCT. This trial aimed to improve tuberculosis (TB) and Human Immunodeficiency Virus (HIV) prevention and care for health workers by enhancing workplace assessment capability, addressing concerns about confidentiality and stigma, and providing onsite counseling, testing, and treatment. An iterative framework was used to synthesize this analysis with lessons taken from other studies. Results: The checklist of critical factors was grouped into eight categories: 1) Building trust and shared ownership; 2) Conducting feasibility studies throughout the process; 3) Building capacity; 4) Creating an appropriate information system; 5) Conducting pilot studies; 6) Securing stakeholder support, with a view to scale-up; 7) Continuously refining methodological rigor; and 8) Explicitly addressing all ethical issues both at the start and continuously as they arise. Conclusion: Researchers should allow for the significant investment of time and resources required for successful implementation of population health RCTs within North–South collaborations, recognize the iterative nature of the process, and be prepared to revise protocols as challenges emerge

All Hands on Deck: Transdisciplinary Approaches to Emerging Infectious Disease

The increasing burden of emerging infectious diseases worldwide confronts us with numerous challenges, including the imperative to design research and responses that are commensurate to understanding the complex social and ecological contexts in which infectious diseases occur. A diverse group of scientists met in Hawaii in March 2005 to discuss the linked social and ecological contexts in which infectious diseases emerge. A subset of the meeting was a group that focused on ‘‘transdisciplinary approaches’’ to integrating knowledge across and beyond academic disciplines in order to improve prevention and control of emerging infections. This article is based on the discussions of that group. Here, we outline the epidemiological legacy that has dominated infectious disease research and control up until now, and introduce the role of new, transdisciplinary and systems-based approaches to emerging infectious diseases.Wedescribe four cases of transboundary health issues and use them to discuss the potential benefits, as well as the inherent difficulties, in understanding the social–ecological contexts in which infectious diseases occur and of using transdisciplinary approaches to deal with them

POTENSI PRODUKSI BERBAGAI VARIETAS PADI SAWAH PADA LAHAN BERTEKSTUR PASIR DENGAN MODEL PENGELOLAAN AIR DAN SISTEM TANAM DI MUSIM TANAM RENDENGAN

Penelitian ini diharapkan dapat mengatasi terjadinya kekurangan air pada lahan sawah irigasi dengan penggunaan varietas adaftif. Inovasi teknologi pada perbaikan mutu intensifikasi dengan sistem mekanisasi salah satu alternatif menanggulangi tenaga kerja manusia. Melalui penerapan efisiensi pengelolaan air irigasi akibat pola perubahan iklim, menghasilkan varietas yang toleran terhadap kekeringan serta penggunaan paket teknologi yang sesuai musim tanam dan tipe hujan equatorial pada tekstur pasir. Tujuan penelitian untuk memperoleh model pengelolaan air dengan sistem tanam metode SRI yang dikombinasi dengan cara legowo dan penggunaan varietas padi yang sesuai kondisi wilayah tipe hujan equatorial. Penelitian dilaksanakan di Kabupaten Sidrap pada lahan bertekstur pasir, penelitian dalam bentuk percobaan dengan metode analisis Rancangan Petak Terpisah. Perlakuan pengelolaan air yakni metode basah-kering, macak-macak dan terputus-putus sebagai petak utama dan berbagai varietas terdiri dari Mekongga, Inpari-4 dan Inpari-30 sebagai anak petak. Hasil penelitian menunjukkan pengelolaan air dengan metode basah-kering memberikan pengaruh yang lebih baik pada tinggi tanaman umur 30 hst (44,74 cm), umur 60 hst (84,74 cm), saat panen (101,62 cm), panjang malai (27,87 cm) dan petak (per hektar) yakni 223,75 kg (6,78 t), sedangkan jumlah anakan 30 hst (20,80 batang), anakan produktif (21,20 batang) diperoleh pada metode terputus-putus. Pengembangan varietas pada lahan sawah bertekstur pasir sebaiknya menggunakan varietas Inpari-4 yang dikombinasikan dengan pengelolaan air dengan metode basah kering

Factors Affecting the Effectiveness of Inter-Dialectical Accommodation among the Sellers-Buyers Discourse

In this research, the researchers convince the readers about factors that affecting the effectiveness of Inter-dialectical accommodation among sellers-buyers. In this research, they prove how the theory of Giles cannot cover the discourse among sellers and buyers in terms of accommodation,   which is done in Central Lombok Nusa Tenggara Barat Province. The researchers describe the phenomenon of the inter-dialectical accommodation in the dialect of Meno-mene versus Meriak-meriku. The object of this research is the activities of sellers-buyers in doing the transaction in the market. The data in this research is taken through observation, recording, interview and note taking of the accommodation among sellers and buyers discourse in some markets in Praya Barat, Praya and Jonggat Sub-district. The researchers use the interpretative qualitative method with some data to reflect the condition of sellers versus buyers discourse in the market. The researchers find the preliminary data shows that the Giles Convergence Theory is un-effective or not applicable in the market where sellers and buyers of Meno-mene versus Meriak-meriku assemble and do a transaction. However, the research result shows the un-effectiveness or there is no effect of converging in bargaining. This research reveals that the convergence theory by Giles cannot be generalized into all part of the discourse, especially in the dialect of Meno-mene versus Meriak-meriku

The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm

With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of three case studies of research conducted in LMICs.We apply emerging ethical guidelines and principles specific to global health research and offer practical strategies that researchers ought to consider. We present case studies in which Canadian health professional students conducted a health promotion project in a community in Honduras; a research capacity-building program in South Africa, in which Canadian students also worked alongside LMIC partners; and a community-university partnered research capacity-building program in which Ecuadorean graduate students, some working alongside Canadian students, conducted community-based health research projects in Ecuadorean communities.We examine each case, identifying ethical issues that emerged and how new ethical paradigms being promoted could be concretely applied.We conclude that research ethics boards should focus not only on protecting individual integrity and human dignity in health studies but also on beneficence and non-maleficence at the community level, explicitly considering social justice issues and local capacity-building imperatives.We conclude that researchers from HICs interested in global health research must work with LMIC partners to implement collaborative processes for assuring ethical research that respects local knowledge, cultural factors, the social determination of health, community participation and partnership, and making social accountability a paramount concern

Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost

Background: Endovascular thrombectomy improves functional outcome in large vessel occlusion ischemic stroke. We examined disability, quality of life, survival and acute care costs in the EXTEND-IA trial, which used CT-perfusion imaging selection. Methods: Large vessel ischemic stroke patients with favorable CT-perfusion were randomized to endovascular thrombectomy after alteplase versus alteplase-only. Clinical outcome was prospectively measured using 90-day modified Rankin scale (mRS). Individual patient expected survival and net difference in Disability/Quality-adjusted life years (DALY/QALY) up to 15 years from stroke were modeled using age, sex, 90-day mRS, and utility scores. Level of care within the first 90 days was prospectively measured and used to estimate procedure and inpatient care costs (US$reference year 2014). Results: There were 70 patients, 35 in each arm, mean age 69, median NIHSS 15 (IQR 12-19). The median (IQR) disability-weighted utility score at 90 days was 0.65 (0.00-0.91) in the alteplase-only versus 0.91 (0.65-1.00) in the endovascular group (p = 0.005). Modeled life expectancy was greater in the endovascular versus alteplaseonly group (median 15.6 versus 11.2 years, p = 0.02). The endovascular thrombectomy group had fewer simulated DALYs lost over 15 years [median (IQR) 5.5 (3.2-8.7) versus 8.9 (4.7-13.8), p = 0.02] and more QALY gained [median (IQR) 9.3 (4.2-13.1) versus 4.9 (0.3-8.5), p = 0.03]. Endovascular patients spent less time in hospital [median (IQR) 5 (3-11) days versus 8 (5-14) days, p = 0.04] and rehabilitation [median (IQR) 0 (0-28) versus 27 (0-65) days, p = 0.03]. The estimated inpatient costs in the first 90 days were less in the thrombectomy group (average US$15,689 versus US$30,569, p = 0.008) offsetting the costs of interhospital transport and the thrombectomy procedure (average US$10,515). The average saving per patient treated with thrombectomy was US$4,365. c Conclusion: Thrombectomy patients with large vessel occlusion and salvageable tissue on CT-perfusion had reduced length of stay and overall costs to 90 days. There was evidence of clinically relevant improvement in long-term survival and quality of life.Peer reviewe

DIXON’S SIT SUBTYPE OF REST VERBS IN ENGLISH AND BUGINESE

Sit Subtype refers to a stance of resting, some verbs specification of Locus is obligator and other it is optional. The aims of this research were (1) To identify Rest verbs in English and Buginese based on the Sit subtypes divided by Dixon. (2) To investigate the differences and similarities in terms of semantical and grammatical construction of Sit subtypes of Rest verbs in English and Buginese. English data were collected from Corpus of Contemporary American English (COCA), while data of Buginese were obtained from field research through process of observation and in depth interview. Both of the data were analyzed with description and qualitative analysis. The result of this research shows that (1) There are nine rest verbs of Sit subtype in English, they are sit (down), stand (up), lie (down), kneel, crouch, squat, lean, hang (down), and float, while in Buginese, there nineteen of Sit subtype: ttudang, ccado’, sEppo’, massampiang, massulekka, makkaddao uttu, mattulak sadang, mappasilojo’, mappalempu, tettong, llEu, maggalelu, mattojang, makkaluttu, ccuku’, rroko’, maccekkeng, ssanrE’, maggattung, and mmawang. (2) The main differences of rest verbs in English and Buginese based on Sit subtype can be seen from two aspects, clause structure and a stance of resting. From clause structure, In English a NP is followed by VP, while in Buginese is permissible that VP is followed by NP that marked by suffix –I in VP. From a stance of resting aspect, cultural background plays important role determining the variants of the rest verb