Health Systems and Health Care Management Panel

8 graduate student/recent graduate presentations on varying topics of health systems and health care management. Moderated by Dr. Nitin Mohan. Reporting of panel done by current GHS students of the 2021 class. Abstracts can be found under Africa-Western Collaborations Day 2020 Abstracts . Presenters as follows: Gojjam Limenih, What Are We Doing? Is Exporting Anti-Depressants the Answer to the Mental Health Needs of the Global South? Jean Pierre Ndayisenga et al., Rwandan Nursing and Midwifery Faculty\u27s Experiences of Applying Knowledge about Teaching Methodology to Practice in Academic and Clinical Settings with Students Mary Ndu, A Literature Review of Barriers to Scaling Up Vasectomy Among Men of Reproductive Age in Nigeria: A Gender Perspective Aimable Nkurunziza et al., Assessment of the Medication Interruptions Among Nurses Working in Paediatric Unit at University Teaching Hospital of Kigali Amy Olson et al., Murses\u27s and Nurse Educator\u27s Experiences of Applying Knowledge and Skills to Clinical and Academic Settings in Rwanda after Participating as Learners in Paediatric Nursing Continuing Professional Development Program Sibylle Ugirase, The Effect of Interprofessional Conflict Resolution on Interprofessional Collaborative Practice among Healthcare Providers in Hospitals Joel Zhang et al., Using a One Health Approach to Address the Challenges Posed by Tuberculosis at the Human-Animal Interface in Kajiado County in Keny

Low-Power High-Performance Ternary Content Addressable Memory Circuits

Ternary content addressable memories (TCAMs) are hardware-based parallel lookup tables with bit-level masking capability. They are attractive for applications such as packet forwarding and classification in network routers. Despite the attractive features of TCAMs, high power consumption is one of the most critical challenges faced by TCAM designers. This work proposes circuit techniques for reducing TCAM power consumption. The main contribution of this work is divided in two parts: (i) reduction in match line (ML) sensing energy, and (ii) static-power reduction techniques. The ML sensing energy is reduced by employing (i) positive-feedback ML sense amplifiers (MLSAs), (ii) low-capacitance comparison logic, and (iii) low-power ML-segmentation techniques. The positive-feedback MLSAs include both resistive and active feedback to reduce the ML sensing energy. A body-bias technique can further improve the feedback action at the expense of additional area and ML capacitance. The measurement results of the active-feedback MLSA show 50-56% reduction in ML sensing energy. The measurement results of the proposed low-capacitance comparison logic show 25% and 42% reductions in ML sensing energy and time, respectively, which can further be improved by careful layout. The low-power ML-segmentation techniques include dual ML TCAM and charge-shared ML. Simulation results of the dual ML TCAM that connects two sides of the comparison logic to two ML segments for sequential sensing show 43% power savings for a small (4%) trade-off in the search speed. The charge-shared ML scheme achieves power savings by partial recycling of the charge stored in the first ML segment. Chip measurement results show that the charge-shared ML scheme results in 11% and 9% reductions in ML sensing time and energy, respectively, which can be improved to 19-25% by using a digitally controlled charge sharing time-window and a slightly modified MLSA. The static power reduction is achieved by a dual-VDD technique and low-leakage TCAM cells. The dual-VDD technique trades-off the excess noise margin of MLSA for smaller cell leakage by applying a smaller VDD to TCAM cells and a larger VDD to the peripheral circuits. The low-leakage TCAM cells trade off the speed of READ and WRITE operations for smaller cell area and leakage. Finally, design and testing of a complete TCAM chip are presented, and compared with other published designs

Case 9 : Managing Expectations: Lyme Disease

Increasing cases of Lyme disease are creating public outcry. The Public Health Agency of Canada (PHAC) has been tasked with the surveillance and guidance for this tick-borne disease but has not seen additional funding. Evidence-based analysis has indicated the most impactful use of resources would be spent on prevention and awareness. Despite this information, the push for increasing the healthcare budget to allow for more Lyme disease funding is growing. A desire to increase resources for acute care in the hopes of better diagnostic testing, more freely prescribed antibiotics, and dedicated Lyme clinics is being put forward from advocacy groups. As climate change worsens, Lyme incidences rising in the foreseeable future is probable. As the president of PHAC, managing different stakeholders within and outside of the organization while managing expectations is crucial. The ability to engage and inform while maintaining a positive public perception is key, as this will lay the framework for other initiatives to launch in the future. Balancing this delicate situation while maintaining an evidence-based approach will take caution and strategic skills

CASE 7: Implementation Research: A Strategy for Developing Indigenous-Specific Intercultural Competency Training Programs (Part B)

Nia Singh is an intercultural education specialist and leads the Intercultural Safety Training Program (ISTP) at the Southwestern Ontario Intercultural Education Centre (SOIEC). She has undertaken significant work with the ISTP developing and implementing training sessions and webinars to help clients make their workplace more culturally competent. Nia has recently observed that the ISTP could greatly benefit from including training materials to help health care practitioners provide improved health care to Indigenous patients. Indigenous people face numerous social, political, historical barriers while accessing healthcare services in Canada. Cultural differences can also lead healthcare practitioners to discriminate against their Indigenous patients and consequently, lead to worsening health outcomes (Harfield et al., 2018). Therefore, seeing the need for an Indigenous-specific program aimed at improving the intercultural competence and awareness of health care professionals, Nia contacted relevant stakeholders to help her research and develop a training module. With the background research and stakeholder input complete, Nia is finalizing the training module and delivery plan. She is now faced with the task of optimally implementing the training and assessing the challenges that may arise as the training is disseminated to its intended audience. During the implementation phase of the process, Nia collaborates with prospective clients to ensure the training module is used effectively and successfully fosters important dialogue about health equity and patientcentred care among health care professionals. At the end of the case, Nia decides to collaborate with the Middlesex-London Public Health Unit’s Indigenous Health Coordinator, Vanessa Anderson, to draft an implementation research proposal so she can assess the impact of the new training program and evaluate it as it is disseminated in a practical, real-world setting. This case is intended to provide students practice with contextualizing an implementation research plan so they can assess an Indigenous-specific cultural safety training program through an Indigenous lens. In addition, it will help students consider the value of multiple stakeholder perspectives while implementing these types of programs

CASE 5: A Stakeholder Analysis: Developing an Indigenous-Specific Intercultural Competency Training Module (Part A)

The case focuses on developing an Indigenous-specific intercultural competency training module and outlines the steps needed to achieve this, with particular emphasis on the importance of conducting a stakeholder analysis and developing a stakeholder engagement plan. The protagonist of the case, Nia Singh, heads up the Intercultural Education Program at the Southwestern Ontario Intercultural Education Centre. After working at the organization as an intercultural education specialist for several years, Nia is looking to expand her project portfolio by redesigning the Intercultural Education Program’s pre-existing Indigenous intercultural competency training module. Nia determines the objective of the new training module will be to educate health care workers about the importance of intercultural competency within health care organizations. Specifically, the module will focus on Indigenous populations and will aim to improve the quality of care they receive so their long-term health outcomes ultimately improve. Nia works with her colleague, Steven Miller, to complete a stakeholder analysis and engagement plan, and they use four different steps to accomplish this: 1) brainstorming all possible stakeholders who have a vested interest in the training module; 2) prioritizing and categorizing each stakeholder as a core stakeholder, involved stakeholder, supportive stakeholder, or peripheral stakeholder; 3) determining the level of engagement required for each stakeholder; and 4) determining which engagement strategies to use for each stakeholder. After completing the stakeholder analysis and engagement plan, Nia and Steven arrange to interview the key stakeholders in order to gather additional opinions, ideas, and perspectives related to developing the training module. These stakeholders include health care workers, Indigenous community members, and other relevant informants. Once the interview process is complete, Nia and Steven develop a pilot version of the training module that is ready to be implemented on a small scale. However, Nia and Steven know they still have their work cut out for them in terms of identifying an effective implementation strategy. This case is intended to be a skills practice case with the primary objective of having students learn about conducting a stakeholder analysis and then learn about stakeholder engagement. By examining this case and completing the learning team activity, students will be able to understand the importance of stakeholder analysis and stakeholder engagement as they relate to developing an Indigenous-specific intercultural competency training module. Once students have acquired this knowledge, they will be able to apply stakeholder analyses and engagement strategies to developing a variety of public health programs. However, given that the training module focuses on Indigenous populations, the case will focus on concepts related to health equity and the barriers faced by Indigenous people when they access health care services. A secondary learning objective is for students to acquire knowledge pertaining to intercultural competency, particularly in terms of its significance within the field of public health and how it can be used as a strategy for reducing health disparities for other marginalized populations

EPIDEMIOLOGICAL AND CLINICAL PROFILE OF STRONGYLOIDIASIS - EXPERIENCE FROM A TERTIARY CARE CENTRE

Objectives: The objective of the study was to study the clinical presentations, predisposing factors, and underlying conditions associated with Strongyloidiasis. Methods: A prospective observational study was conducted from 2018 to 2021on patients who presented with medical complaints in a tertiary care hospital, and 19 were diagnosed with strongyloidiasis by stool wet mount examination. Other relevant details were collected to analyze the risk factors. Results: A total of 19 cases were found positive for strongyloidiasis. Males 13 (68.4%) were more and females 6 (31.6%), and most of them were above 50 years age group (73.7%). Among the cases, respiratory symptoms (42.1%) were predominantly observed, followed by gastrointestinal (31.6%). Multiple predisposing factors such as chronic obstructive pulmonary disease, corticosteroid usage, TB, diabetes, alcohol, and asthma have been identified in strongyloidiasis cases. Peripheral eosinophilia is a frequent finding in the complete blood picture. Conclusions: Strongyloidiasis should be strongly suspected in every immune compromised patient presenting with gastrointestinal, respiratory manifestations, or peripheral eosinophilia, and asymptomatic immune competent patients with comorbid conditions

Comparative Analysis of Glass-Basalt-Plastic Materials for Construction in Arctic Conditions

This research presents a comprehensive comparative analysis of glass-basalt-plastic (GBP) materials intended for construction purposes in challenging Arctic conditions. The study investigates the mechanical, thermal, and durability properties of GBP composites, considering their potential application in structures subjected to extreme cold temperatures and other environmental challenges prevalent in Arctic regions. Through a series of experimental evaluations and analytical assessments, we aim to provide insights into the performance characteristics of GBP materials when compared to conventional construction materials. The findings of this research contribute to the understanding of the suitability and limitations of GBP composites in Arctic construction, addressing key factors such as structural integrity, thermal insulation, and resistance to environmental degradation. The results presented in this article serve as a valuable resource for engineers, architects, and researchers involved in the design and implementation of infrastructure projects in Arctic environments. As the demand for sustainable and resilient construction materials grows, this study offers a timely exploration of the potential benefits and considerations associated with the use of GBP materials in extreme climatic conditions

Clinical pharmacokinetics and pharmacodynamics of vildagliptin 50 mg sustained release tablet formulation in healthy Indian males after single and multiple-dose

Background: Vildagliptin 50 mg once-daily is a clinically established anti-diabetic therapy in combination with a sulphonylurea and renally impaired patients. We developed sustained release (SR) vildagliptin 50 mg tablet formulation for prolongation of dipeptidyl peptidase-4 (DPP-4) inhibition coverage. The present study compares the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics of investigational vildagliptin SR 50 mg tablet with Galvus® in healthy Indian adult males after single and multiple-dose administration.Methods: Each randomized, open-label, two-period, cross-over study enrolled 36 healthy Indian adult male subjects for the assessment of single and multiple-dose PK/PD profiles of SR 50 mg vildagliptin under fed condition. The plasma drug concentrations were quantified using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. PK parameters (Cmax (ng/ml), AUC0-18, AUC0-36, and AUC0-τ (ng.hr/ml), Tmax (hour), t1/2 (hour), Tmaxss (hour), Cτss (ng.hr/ml) were calculated using Phoenix® WinNonlin® software. The DPP-4 inhibition was determined in a fluorescence-based assay.Results: Vildagliptin SR tablet showed prolonged PK/PD characters compared to Galvus®. All PK parameters expressed as Mean±SD. The single-dose PK measures were Cmax (58.22±11.31), AUC0-18 (556.92±135.84), AUC0-36 (608.82±159.84), Tmax (6.48±3.78). In the multiple-dose study, PK findings were Cmax (73.20±17.71), AUC0-τ (714.36±303.21), Cτss (4.15±6.51), Tmaxss (5.60±3.12). Vildagliptin SR 50 mg achieved prolonged DPP-4 inhibition (≥80%) for18-20 hours after single and multiple-dose administration as compared to Galvus® (12-13 hours).Conclusions: Investigational vildagliptin SR tablet was found safe, well-tolerated after single and multiple-dose administration. Its extended DPP-4 inhibition profile compared to Galvus® may benefit the patient population on combination therapy with a sulphonylurea and renally impaired patients