Collaboration between Developed and Developing Countries Offers Opportunities to Amplify Global Health Research

Slides for Ms. Omollo's portion of the panel are available at http://openmi.ch/sts13ahon.The complexity, scope and intensity of global health challenges demand international collaboration. Collaboration between developing and developed countries can be an effective strategy for tackling shared health issues. In recent years, government agencies and foundations have increased financial and human resources for international collaborative projects for health research and education. However, these international partnerships often encounter barriers such as resource, capacity, political and cultural differences which affect the motivations, balance of benefits, regulation of research, and ultimately outcomes of these programs. The current literature is resplendent with anecdotal reports, editorials and thematic introductions about attitudes and structural factors impacting partnerships between developing and developed countries. There is little research or documentation regarding systematic analysis of the social and technical factors that foster efficient, effective and sustainable international collaboration. The panelists will present three unique models of collaboration between developing and developed countries. They will examine the social, scientific, technological and organizational dynamics of these collaborations that must be aligned to effectively address challenges resulting from resource, capacity and power differences in the interaction of multiple organizational and national cultures. The lessons learned from these collaborations are intended to inform institutions and researchers who are engaged in multicultural and multinational health networks. The findings may also be a useful reference for policy makers and funding agencies for predicting and evaluating success of collaborative projects. The first panelist will present on the National Heart Lung and Blood – United Health Global Health Centers of Excellence (COE) Program (http://www.nhlbi.nih.gov/about/globalhealth/centers/index.htm). Each COE collaborates with a research organization in a developed country to develop research and training infrastructure and to build capacity to conduct population based or clinical research to monitor, control or prevent cardiovascular and pulmonary diseases (CVPD). The program includes an Administrative Coordinating Center that coordinates and manages network communication, tracks COE research, training and capacity building activities, and offers consultations related to methodology, outcome measures and data management for collaborative studies. The panelist will discuss mid-point process evaluation and how findings from the evaluation are guiding the direction of the program through the end of the funding period. The second panelist will present on University of Michigan Health Systems-Peking University Health Science Center Joint Institute for Translational and Clinical Research (JI) (http://www.puuma.org/). The JI is a virtual cross-institutional research platform destined to facilitate high-impact, collaborative research to advance global health. The panelist will focus on how to develop shared and individual institutional management structures, processes and technical infrastructure that supports and sustains successful cross-institutional collaboration. The third panelist will discuss the African Health OER Network (“the Network”) (http://www.oerafrica.org/healthoer), a collaborative project between University of Michigan, an NGO in Africa, two universities in Ghana, and two universities in South Africa. The objective of this project is to advance health education in Africa by creating and promoting free, openly licensed teaching materials by African academics to share knowledge, address curriculum gaps, and support health education communities. The panelist will present a collaboration model that involves an iterative process of action, assessment, and reflection. She will summarize the communication and management practices developed through the interactive process that enabled the Network to implement the shared values of transparency, collaboration, and active participation, to foster South-South as well as North-South exchanges, and to ultimately achieve project goals and sustainability.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102597/1/2013_Luo-et-al-SciTS_Cross-Cultural and International Team Science.docxhttp://deepblue.lib.umich.edu/bitstream/2027.42/102597/2/2013_Luo-et-al-SciTS_Cross-Cultural and International Team Science.pd

Lectura De Contexto Y Abordaje Psicosocial Desde Los Enfoques Narrativos

El Programa de Atención Psicosocial y Salud Integral a Víctimas forma parte de las medidas de asistencia y rehabilitación emanadas en la Ley 1448 de 2011, las cuales buscan el restablecimiento de las condiciones físicas y psicosociales de la población víctima y la garantía del derecho a la atención en salud física, mental y psicosocial, dentro de unos marcos éticos que permitan la dignificación y la recuperación de los efectos ocasionados como consecuencia de las Graves Violaciones a los Derechos Humanos e Infracciones al Derecho Internacional Humanitario en el marco del conflicto armado en Colombia ha sido elaborado por el Ministerio de Salud y Protección Social partiendo de los Lineamientos de Intervención Psicosocial en respuesta a los daños producidos por el conflicto armado, los aportes que diversas organizaciones de la sociedad civil han realizado a través de múltiples acciones y proyectos en favor de las víctimas del conflicto armado en nuestro país, las ordenes de la Corte Constitucional en la Sentencia T-025 de 2004 y sus autos de Seguimiento, las órdenes complejas emitidas por esta misma Alta Corte al Estado Colombiano a través de la Sentencia T-045 de 2010 y, la promulgación por parte del Gobierno Nacional de la Ley 1448 de 2011 para la Atención, Asistencia y Reparación Integral a las Víctimas, con sus decretos reglamentarios que obligan a garantizar atención en salud con enfoque psicosocial a las víctimas del conflicto armado, así como la rehabilitación física, mental y psicosocial a quienes la requieran .The Program of Psychosocial Care and Integral Health to Victims is part of the assistance and rehabilitation measures issued in Law 1448 of 2011, which seek the restoration of the physical and psychosocial conditions of the victim population and the guarantee of the right to care in physical, mental and psychosocial health, within ethical frameworks that allow the dignification and recovery of the effects caused as a result of the serious violations of Human Rights and Infractions of International Humanitarian Law in the context of the armed conflict in Colombia. prepared by the Ministry of Health and Social Protection based on the Psychosocial Intervention Guidelines in response to the damage caused by the armed conflict, the contributions that various civil society organizations have made through multiple actions and projects in favor of the victims of the armed conflict in our country, the o Orders of the Constitutional Court in Sentence T-025 of 2004 and its follow-up orders, the complex orders issued by this same High Court to the Colombian State through Sentence T-045 of 2010 and, the promulgation by the National Government of Law 1448 of 2011 for Attention, Assistance and Comprehensive Reparation for Victims, with its regulatory decrees that require guaranteeing health care with a psychosocial approach to the victims of the armed conflict, as well as physical, mental and psychosocial rehabilitation for those they require it

Increased Doses Lead to Higher Drug Exposures of Levofloxacin for Treatment of Tuberculosis

Patients with multidrug-resistant tuberculosis in Peru and South Africa were randomized to a weight-banded nominal dose of 11, 14, 17, or 20 mg/kg/day levofloxacin (minimum, 750 mg) in combination with other second-line agents. A total of 101 patients were included in noncompartmental pharmacokinetic analyses. Respective median areas under the concentration-time curve from 0 to 24 h (AUC0-24) were 109.49, 97.86, 145.33, and 207.04 μg · h/ml. Median maximum plasma concentration (Cmax) were 11.90, 12.02, 14.86, and 19.17 μg/ml, respectively. Higher levofloxacin doses, up to 1,500 mg daily, resulted in higher exposures. (This study has been registered at ClinicalTrials.gov under identifier NCT01918397.)

An optimized background regimen design to evaluate the contribution of levofloxacin to multidrug-resistant tuberculosis treatment regimens: study protocol for a randomized controlled trial.

BACKGROUND:Current guidelines for treatment of multidrug-resistant tuberculosis (MDR-TB) are largely based on expert opinion and observational data. Fluoroquinolones remain an essential part of MDR-TB treatment, but the optimal dose of fluoroquinolones as part of the regimen has not been defined. METHODS/DESIGN:We designed a randomized, blinded, phase II trial in MDR-TB patients comparing across levofloxacin doses of 11, 14, 17 and 20 mg/kg/day, all within an optimized background regimen. We assess pharmacokinetics, efficacy, safety and tolerability of regimens containing each of these doses. The primary efficacy outcome is time to culture conversion over the first 6 months of treatment. The study aims to determine the area under the curve (AUC) of the levofloxacin serum concentration in the 24 hours after dosing divided by the minimal inhibitory concentration of the patient's Mycobacterium tuberculosis isolate that inhibits > 90% of organisms (AUC/MIC) that maximizes efficacy and the AUC that maximizes safety and tolerability in the context of an MDR-TB treatment regimen. DISCUSSION:Fluoroquinolones are an integral part of recommended MDR-TB regimens. Little is known about how to optimize dosing for efficacy while maintaining acceptable toxicity. This study will provide evidence to support revised dosing guidelines for the use of levofloxacin as part of combination regimens for treatment of MDR-TB. The novel methodology can be adapted to elucidate the effect of other single agents in multidrug antibiotic treatment regimens. TRIAL REGISTRATION:ClinicalTrials.gov, NCT01918397 . Registered on 5 August 2013

La fonction résidentielle dans un centre-ville en mutation : le cas de la ville de Chicoutimi,

La présente recherche s'inscrit dans le cadre du Programme de Maîtrise en Etude des Sociétés Régionales et constitue une exigence essentielle à l'obtention du diplôme de fin d'études. Bien que très spécialisée et davantage tournée vers les disciplines de l'urbanisme et de la géographie urbaine, celle-ci s'inscrit dans le cadre de l'analyse du phénomène régional. La ville de Chicoutimi n'est certes pas l'image-type des villes de la région du Saguenay-Lac-St-Jean mais elle en constitue cependant l'une des composantes importantes qu'il importe de connaître. Ainsi, dans l'analyse du phénomène d'évolution des centres-villes en milieu périphérique tel la région du Saguenay-Lac-St-Jean, il importe de connaître en premier chef, ce qui se passe à 1'intérieur des villes les plus populeuses. En fournissant pour la ville de Chicoutimi différentes données sur les caractéristiques socio-économiques des résidents et sur les conditions générales d'habitabilité dans la zone centrale, nous pensons apporter une contribution supplémentaire au domaine de recherche particulier que constitue la géographie urbaine