Alien Registration- Martineau, Lydia P. (Lewiston, Androscoggin County)

https://digitalmaine.com/alien_docs/28958/thumbnail.jp

Can Action Research Strengthen District Health Management and Improve Health Workforce Performance? A Research Protocol.

The single biggest barrier for countries in sub-Saharan Africa (SSA) to scale up the necessary health services for addressing the three health-related Millennium Development Goals and achieving Universal Health Coverage is the lack of an adequate and well-performing health workforce. This deficit needs to be addressed both by training more new health personnel and by improving the performance of the existing and future health workforce. However, efforts have mostly been focused on training new staff and less on improving the performance of the existing health workforce. The purpose of this paper is to disseminate the protocol for the PERFORM project and reflect on the key challenges encountered during the development of this methodology and how they are being overcome. The overall aim of the PERFORM project is to identify ways of strengthening district management in order to address health workforce inadequacies by improving health workforce performance in SSA. The study will take place in three districts each in Ghana, Tanzania and Uganda using an action research approach. With the support of the country research teams, the district health management teams (DHMTs) will lead on planning, implementation, observation, reflection and redefinition of the activities in the study. Taking into account the national and local human resource (HR) and health systems (HS) policies and practices already in place, 'bundles' of HR/HS strategies that are feasible within the context and affordable within the districts' budget will be developed by the DHMTs to strengthen priority areas of health workforce performance. A comparative analysis of the findings from the three districts in each country will add new knowledge on the effects of these HR/HS bundles on DHMT management and workforce performance and the impact of an action research approach on improving the effectiveness of the DHMTs in implementing these interventions. Different challenges were faced during the development of the methodology. These include the changing context in the study districts, competing with other projects and duties for the time of district managers, complexity of the study design, maintaining the anonymity and confidentiality of study participants as well as how to record the processes during the study. We also discuss how these challenges are being addressed. The dissemination of this research protocol is intended to generate interest in the PERFORM project and also stimulate discussion on the use of action research in complex studies such as this on strengthening district health management to improve health workforce performance

Quantifying the variability of the annular modes: reanalysis uncertainty vs. sampling uncertainty

The annular modes characterize the dominant variability of the extratropical circulation in each hemisphere, quantifying vacillations in the position of the tropospheric jet streams and the strength of the stratospheric polar vortices. Their representation in all available reanalysis products is assessed. Reanalysis uncertainty associated with limitations in the ability to constrain the circulation with available observations, i.e., the inter-reanalysis spread, is contrasted with sampling uncertainty associated with the finite length of the reanalysis records.It is shown that the annular modes are extremely consistent across all modern reanalyses during the satellite era (ca. 1979 onward). Consequently, uncertainty in annular mode variability, e.g., the coupling between the stratosphere and troposphere and the variation in the amplitude and timescale of jet variations throughout the annual cycle, is dominated by sampling uncertainty. Comparison of reanalyses based on conventional (i.e., nonsatellite) or surface observations alone with those using all available observations indicates that there is limited ability to characterize the Southern Annular Mode (SAM) in the presatellite era. Notably, prior to 1979, surface-input reanalyses better capture the SAM at near-surface levels than full-input reanalyses. For the Northern Annular Mode, however, there is evidence that conventional observations are sufficient, at least from 1958 onward. The addition of 2 additional decades of records substantially reduces sampling uncertainty in several key measures of annular mode variability, demonstrating the value of more historic reanalyses. Implications for the assessment of atmospheric models and the strength of coupling between the surface and upper atmosphere are discussed.</p

Elevated hepatocyte growth factor levels in osteoarthritis osteoblasts contribute to their altered response to bone morphogenetic protein-2 and reduced mineralization capacity

PURPOSE: Clinical and in vitro studies suggest that subchondral bone sclerosis due to abnormal osteoblasts is involved in the progression of osteoarthritis (OA). Human osteoblasts isolated from sclerotic subchondral OA bone tissue show an altered phenotype, a decreased canonical Wnt/ß-catenin pathway, and a reduced mineralization in vitro as well as in vivo. These alterations were linked with an abnormal response to BMP-2. OA osteoblasts release factors such as the hepatocyte growth factor (HGF) that contribute to cartilage loss whereas chondrocytes do not express HGF. HGF can stimulate BMP-2 expression in human osteoblasts, however, the role of HGF and its effect in OA osteoblasts remains unknown. Here we investigated whether elevated endogenous HGF levels in OA osteoblasts are responsible for their altered response to BMP-2. METHODS: We prepared primary human subchondral osteoblasts using the sclerotic medial portion of the tibial plateaus of OA patients undergoing total knee arthroplasty, or from tibial plateaus of normal individuals obtained at autopsy. The expression of HGF was evaluated by qRT-PCR and the protein production by western blot analysis. HGF expression was reduced with siRNA technique whereas its activity was inhibited using the selective inhibitor PHA665752. Alkaline phosphatase activity (ALPase) and osteocalcin release were measured by substrate hydrolysis and EIA respectively. Canonical Wnt/β-catenin signaling (cWnt) was evaluated both by target gene expression using the TOPflash TCF/lef luciferase reporter assay and western blot analysis of β-catenin levels in response to Wnt3a stimulation. Mineralization in response to BMP-2 was evaluated by alizarin red staining. RESULTS: The expression of HGF was increased in OA osteoblasts compared to normal osteoblasts and was maintained during their in vitro differentiation. OA osteoblasts released more HGF than normal osteoblasts as assessed by western blot analysis. HGF stimulated the expression of TGF-β1. BMP-2 dose-dependently (1 to 100ng/ml) stimulated both ALPase and osteocalcin in normal osteoblasts whereas, it inhibited them in OA osteoblasts. HGF-siRNA treatments reversed this response in OA osteoblasts and restored the BMP-2 response. cWnt is reduced in OA osteoblasts compared to normal, and HGF-siRNA treatments increased cWnt in OA osteoblasts almost to normal. Smad1/5/8 phosphorylation in response to BMP-2, which is reduced in OA osteoblasts, was corrected when these cells were treated with PHA665752. The BMP-2-dependent mineralization of OA osteoblasts, which is also reduced compared to normal, was only partially restored by PHA665752 treatment whereas 28days treatment with HGF reduced the mineralization of normal osteoblasts. CONCLUSION: OA osteoblasts expressed more HGF than normal osteoblasts. Increased endogenous HGF production in OA osteoblasts stimulated the expression of TGF-β1 and reduced their response to BMP-2. Inhibiting HGF expression or HGF signaling restored the response to BMP-2 and Smad1/5/8 signaling. In addition, decreased HGF signaling partly corrects the abnormal mineralization of OA osteoblasts while increased HGF prevents the normal mineralization of normal osteoblasts. In summary, we hypothesize that sustained elevated HGF levels in OA osteoblasts drive their abnormal phenotype and is implicated in OA pathophysiology

Creación de un centro de servicio eco-turístico múltiple en Portobelo

El trabajo realizado identifica a la comunidad de Portobelo, cabecera del Distrito de Portobelo, como el lugar ideal para la puesta en ejecución de la propuesta de un proyecto Eco-Turístico, que incremente el turismo y por ende, los ingresos de los moradores del lugar. La propuesta, presenta formas alternativas de abordar la problemática del desempleo, la generación de ingreso y del desarrollo de potencialidades creativas. Visualizado de esta manera el proyecto puede ofrecer un estilo de vida satisfactorio para la población de la comunidad de Portobelo irradiando iguales beneficios para los visitantes y residentes. Hay una realidad que nos indica que se requiere aumentar el nivel de bienestar de los residentes de la comunidad de Portobelo, tales como la escasa explotación del potencial histórico cultural y el pobre intento de nuevas alternativas de desarrollo económico. De lo anterior, nace la firmeza de nuestra propuesta y el entusiasmo por generar oportunidades de desarrollo social, cultural y económico en Portobelo. Los responsables directos de su bienestar general son los propios residentes. La propuesta asume el compromiso de la sociedad civil al generar alternativas de solución ante la problemática del desempleo y el Desarrollo Social Sostenible. El sujeto de investigación hace referencia al residente de Portobelo. Se describe su condición social y económica, ya que es relevante en el estudio previo a la presentación de la propuesta del proyecto, debido a la ausencia de estrategias para el mejoramiento de su calidad de vida; decimos esto por considerar que los habitantes de Portobelo, se obligan cada día a la interpretación de posibles oportunidades de empleo generadoras de mejores ingresos que le permitan satisfacer sus necesidades. Se hace referencia a Portobelo como patrimonio histórico de la humanidad resaltando su historia colonial, sus costumbres y tradiciones. También conceptualiza la actividad turística y presenta aspectos importantes de lo turístico en Panamá, el nivel Gerencial para la administración del proyecto que permitirá mejorar el ámbito de vida de los residentes. Estimulando el turismo lograremos un mejor futuro para esta región

Decoherence in the cosmic background radiation

In this paper we analyze the possibility of detecting nontrivial quantum phenomena in observations of the temperature anisotropy of the cosmic background radiation (CBR), for example, if the Universe could be found in a coherent superposition of two states corresponding to different CBR temperatures. Such observations are sensitive to scalar primordial fluctuations but insensitive to tensor fluctuations, which are therefore converted into an environment for the former. Even for a free inflaton field minimally coupled to gravity, scalar-tensor interactions induce enough decoherence among histories of the scalar fluctuations as to render them classical under any realistic probe of their amplitudes.Comment: 15 pages, accepted to be published in Classical and Quantum Gravit