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International training programs in reproductive sciences for conservation of Latin American felids.

Survival of the ten non-domestic felid species endemic to Latin America is imperiled by habitat loss, poaching and poor captive management. Over the past 10 years, conservation of these felids has been the primary focus of a reproductive research and training program conducted in Brazil, Mexico, and the USA. The objectives of this program were to: (1) provide intensive training in reproductive sciences to Latin American scientists, (2) conduct collaborative studies investigating basic and applied reproduction in endangered felids, and (3) establish a highly-trained scientific cohort to conduct independent conservation-based research. Four formal training courses, consisting of didactic lectures and hands-on instruction in research techniques, including semen collection, sperm cryopreservation and laparoscopic artificial insemination (AI), were taught in Brazil and Mexico between 1995 and 1998. Several of these scientists received further training in conducting fecal hormone analysis in the USA, and a number of research studies, many in collaboration with American scientists, were initiated in Latin American felids. Research findings have characterized basal reproductive traits in several felid species, including ocelots, margay, tigrinas and jaguars, and established that Latin American felids exhibit only minimal seasonal variation in most reproductive traits. Other studies have explored the impact of acute and chronic stressors on adrenocortical activity and demonstrated the importance of environmental enrichment in captivity, especially in small felids. Additional research has examined ovarian and immunological responsiveness of Latin American felids to exogenous gonadotropins and assessed the impact of nutrition on sperm production and oocyte quality. Applied reproductive studies have investigated sperm cryopreservation in both captive and wild felid populations and demonstrated the production of viable offspring in ocelots and tigrinas following laparoscopic AI. Ongoing studies are investigating the potential of in vitro fertilization (IVF), embryo cryopreservation and embryo transfer for genetic management of ocelots and tigrinas. To date, over 75 Brazilian ocelot and 50 tigrina IVF embryos have been cryopreserved and two pregnancies have been established in ocelots following transfer of frozen-thawed embryos. Findings from these studies are helping to improve husbandry, population management, and breeding of Latin American felids in captivity. Continued advances in assisted reproduction eventually may provide an alternative route for exchanging genetic material among Latin American felid populations. Most importantly, this collaborative program has been essential for building scientific capacity, within Brazil and Mexico, in establishing a core group of highly-trained reproductive biologists that will continue applying their new knowledge and skills to the conservation of Latin American felids.

Animals↗

Influence of season and environment on adult neurogenesis in the central olfactory pathway of the shore crab, Carcinus maenas.

In most vertebrates hitherto examined including humans, certain brain areas retain the capacity to build new neurons during adult life. In some arthropods, above all in crustaceans, continuous genesis of brain neurons has also been shown, namely for soma clusters of the olfactory brain. Several factors as, e.g., sensory input, living conditions, or stress, are known to influence the rate of cell proliferation, survival, and cell differentiation. The present study was undertaken to test whether seasonal changes and/or captivity would influence the proliferation of cells in the lateral cluster (LC) of the olfactory lobe (OL) and in the cluster of the hemiellipsoid body (HB) of the eyestalk of shore crabs. During a period of more than a year, 5-bromo-deoxyuridine (BrdU) injections were administered to freshly caught animals and to animals kept for 12 weeks after capture under artificial conditions. Counts of BrdU-labeled cells showed that animal size, seasonal changes as well as captivity had an influence on the number of proliferating cells. Further, in the lateral soma cluster and the soma cluster of the hemiellipsoid body, cell proliferation is most likely regulated independently. While the lateral soma cluster showed two peaks of cell proliferation (spring and late summer), the soma cluster of the hemiellipsoid body had only one peak in early summer. Furthermore, proliferation decreased with size and hence age of the animal only in the lateral soma cluster but not in the soma cluster of the hemiellipsoid body. Although captivity reduced the number of newborn cells in general, cell proliferation remained synchronous with the seasons of the year, indicating that an endogenous circannual rhythm regulates neurogenesis.

Animals↗

Excellence in evidence-based practice: organizational and unit exemplars.

The University of Iowa Hospitals and Clinics is a recognized leader in evidence-based practice. Creating organizational excellence in evidence-based practice takes leadership and a committed effort at all levels. Building the capacity, culture, and vision at the organizational and unit levels is needed to promote use of evidence in practice. Practical approaches that have been effective in promoting development of an evidence-based practice program and project are outlined. An exemplar describing development and adoption of an evidence-based project to improve sedation management led to improvements in patient care processes and outcomes.

Algorithms↗

International humanitarian assistance: where do emergency physicians belong?

As human civilization faces new and challenging humanitarian crises, the entrance of EPs into the realm of HA is needed and timely. As noted by Jennifer Leaning [35], an EP at Harvard University, "Medical and public health personnel who respond to these crises enter a domain of perilous complexity. Road maps do not exist, but the possibility of good favors the prepared mind." Thus, with proper training in the principles of public health and experience, EPs have a tremendous opportunity to affect the realm of international HA, particularly via the analysis and development of international emergency health systems and building the capacity for effective relief. EPs with training in HA can be valuable assets to relief programs in the field and administratively, especially after the initial disaster and during the transition to health system reconstruction and development.

Altruism↗

Community perspectives on the impact of policy change on linking social capital in a rural community.

Understanding what undermines or builds social capital is important when estimating the impact that changes in social capital have on people's lives. The aim of this paper is to illustrate how the consequences of neo-liberal policy initiatives have impacted on linking social capital in one small and vibrant rural community in Australia. Policy changes affecting all levels of government and various commercial agencies have undermined people's capability for a range of actions which bring personal and community-wide social and economic returns. Rationalisation and regionalisation of services and commercial agencies, including local government amalgamation, and increased workloads have undermined people's capabilities for community engagement. Policy outcomes are at odds with the stated policy agenda of building community capacity.

Adult↗

FIGO Save the Mothers Initiative: the Pakistan-UK collaboration.

The pilot study in Punjab, Pakistan was one of the five paired demonstration projects sponsored by FIGO in the "Save the Mothers" maternal mortality project. The goal of the project was to bring basic and comprehensive emergency obstetric care (EmOC) to a semiurban and rural area some 30 km from Lahore, where effectively there was none. The aim was to achieve this by using the existing facilities within the rural health system without the deployment of extra specialist staff other than as initial facilitators. This report shows trebling of some performance indicators and an improvement in met need. There is coincidentally a similar increase in the uptake of general medical services. Reducing maternal mortality requires building local capacity for EmOC; the essential components being the premises, trained personnel, equipment, and availability of drugs and blood. Availability and provision of EmOC coupled with changes in the attitude of the population resulted in marked improvement of process indicators.

Data Collection↗

Migration intentions among nigerian neurosurgeons: a national survey of workforce retention.

Physician emigration from low- and middle-income countries creates critical workforce shortages. This study explored factors influencing migration intentions among Nigerian neurosurgeons and trainees. We conducted an anonymized survey of consultant neurosurgeons, fellows, and residents practicing in Nigeria. Invitations were sent by email and professional messaging platforms, and snowball sampling was used to increase participation. The survey included quantitative and open-ended questions on demographics, income, migration plans, and retention factors. Seventy-nine respondents participated (61.5 % consultants; 93.7 % male; median age: 44 years). Nearly all practiced general neurosurgery (97.3 %), and many also performed trauma (65.3 %) and spine (61.3 %) neurosurgery. Most (85.7 %) reported that their earnings were insufficient to support their families. Nearly 40 % were considering emigration, most often citing financial pressures (88.5 %) and poor working conditions (63.5 %) as push factors. By contrast, personal or family ties (63.0 %) and relocation costs (45.2 %) were cited as reasons to stay. Respondents identified higher salaries (58.1 %) and greater investment in the health sector (51.4 %) as key measures to improve retention. In univariable analyses, younger age, income insufficiency, income dissatisfaction, and feeling undervalued at work were associated with migration intention. Financial insecurity emerged as the dominant driver of migration intentions among Nigerian neurosurgeons. In addition to salary increases, sustained investment in healthcare infrastructure and workforce support is essential to improve retention. International partnerships may complement these efforts by building neurosurgical capacity and mitigating brain drain.

Humans↗

Nurses' reflections on pain management in a nursing home setting.

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

Analgesia↗

Recruiting knowledge, not just nurses.

The importance of the definition of nurse as a "knowledge worker" and the utility of knowledge as a recruitment policy for building a strong nursing workforce are discussed. The method used is the implementation of a statewide merit-based scholarship program targeting academically excellent students. At the University of Vermont, which educates roughly half of the state's nursing students, applications to the College of Nursing are up 83 percent, and entering class size is up 92 percent. Most significantly, Scholastic Assessment Test (SAT) scores have improved 4 percent, reversing an 8-year trend. In conclusion, merit scholarships are an effective means of building intellectual capacity and attracting academically stronger candidates to the nursing profession.

Education, Nursing↗

The clinical partnership as strategic alliance.

The purpose of this article is to describe a renewed partnership between a collegiate school of nursing and a community hospital. Universities and hospitals are searching for creative solutions to increase the number of registered nurses available to meet the demand for nursing care. An affiliation agreement had been in existence for many years, but health care system imperatives made it necessary to redesign the partnership between nursing education and nursing service. The model used to develop this new partnership is based on the work done in the field of management and is in the form of a strategic alliance. The success of a strategic alliance depends on two key factors: the relationship between partners and partnership performance. Identified outcomes show that this partnership is helping to meet the increasing demand for nursing care by building student capacity, satisfying mutual needs of faculty and clinical staff, and removing economic barriers. This article describes the development of the strategic alliance, its current status, and strategies for the future.

Connecticut↗

Building public health skills and capacity in the English regions.

Local public health departments have variable access to a public health intelligence function, and information skills are scarce. Public health observatories are supporting the development of professional standards for public health intelligence specialists and offer training opportunities for both defined public health specialists and generalist public health specialists. In addition observatories support public health practice through educational programmes in health impact assessment, health equity audit, public health intelligence, and the provision of toolkits and advice on methods. Observatories have a key role in supporting and developing networks, in particular public health analysts, and the use of interoperable websites is enhancing these opportunities.

Health Personnel↗

'Telling the truth is the best thing': teenage orphans' experiences of parental AIDS-related illness and bereavement in Zimbabwe.

Zimbabwe is one of the countries most affected by HIV/AIDS, and as elsewhere in southern Africa, the impact on children and young people living in affected households is significant. Loss is highly complex and dependent on developmental stage, resilience, quality of care, and social support networks, and often includes a progression of experiences from the onset of a parent's or caregiver's illness, through to the aftermath of death. For several reasons, AIDS-related bereavement is likely to be especially complicated and difficult to accommodate. Understandings of bereavement and grief among African children, and adults' responses to orphans' psychological difficulties, remain under-developed. This paper focuses on the narratives of older children in their teens, who have experienced parental AIDS-related illness and death in six sites in Zimbabwe. A key finding is that, while many orphaned teenagers desire direct communication with adults about parental illness and death, adults themselves--whether the sick parent, other relatives in the household or a caregiver following parental loss--are often ill-equipped to identify and manage children's distress positively. While most existing psychosocial interventions focus on bereaved children, this paper suggests that, in order to create an enabling environment for orphans, building the capacity of key adults in orphans' lives, particularly surviving relatives, caregivers, and teachers to address emotional issues relating to parental loss constructively is an essential, but neglected, area of programming.

Adolescent↗

Challenges and opportunities for donors in reducing maternal death and morbidity: lessons from the PMM experience.

The experience of the PMM Network offers several insights for donors seeking to work on maternal mortality, particularly in Africa where the risk of maternal death is highest. First, the projects provide evidence that multidisciplinary operations research can result in the development and implementation of successful, relatively low-cost interventions. In addition, the work of PMM highlights the need for greater donor funding to build and support partnerships--to include researchers, communities and policymakers--that enhance sustainability of efforts. Finally, the work of the teams confirms the benefits of donor commitment to building local capacity.

Africa, Western↗

Substance abuse treatment and HIV services: Massachusetts' policies and programs.

States and communities use many strategies and policies to facilitate the integration of HIV and AIDS services with alcoholism and drug abuse treatment and prevention programs. Massachusetts' policy initiatives that promoted collaboration between substance abuse programs and AIDS services are outlined. The review begins with an overview of the HIV epidemic in Massachusetts and reflects on the initial challenges of building system capacity so that HIV and substance abuse services could become more closely integrated. The discussion summarizes specific policy strategies implemented to encourage system development and to develop program and staff skills for working with men and women with HIV/AIDS and at risk of infection. The initiatives included integration of alcoholism and drug abuse treatment programs, expansion of Medicaid reimbursement for substance abuse treatment, training and skills development for counselors, and coordinated service development and advocacy for substance abuse and development for counselors, and coordinated service development and advocacy for substance abuse and AIDS/HIV services.

Alcoholism↗

Working with public sector clinics to provide adolescent-friendly services in South Africa.

Health care facilities can play an important role for adolescents in preventing health problems, in promoting sexual and reproductive health and in shaping positive behaviours. Extensive research has established that South African public health facilities are failing to provide adolescent-friendly health services. The National Adolescent-Friendly Clinic Initiative (NAFCI) is an accreditation programme designed to improve the quality of adolescent health services at the primary care level and strengthen the public sector's ability to respond to adolescent health needs. The key objectives of the programme are to make health services more accessible and acceptable to adolescents, establish national standards and criteria for adolescent health care in clinics throughout the country, and build the capacity of health care workers to provide quality services. One of the indicators for success of NAFCI will be increased utilisation of public sector clinics by adolescents. NAFCI is an integral component of the largest, most innovative, public health programme ever launched in South Africa, loveLife. Achieving NAFCI accreditation involves clinic self-appraisals, quality improvements, external assessments and award of achievement stars. NAFCI is currently being piloted in ten government clinics in South Africa.

Adolescent↗

Kinetochore-microtubule interactions during cell division.

Proper segregation of chromosomes during cell division is essential for the maintenance of genetic stability. During this process chromosomes must establish stable functional interactions with microtubules through the kinetochore, a specialized protein structure located on the surface of the centromeric heterochromatin. Stable attachment of kinetochores to a number of microtubules results in the formation of a kinetochore fibre that mediates chromosome movement. How the kinetochore fibre is formed and how chromosome motion is produced and regulated remain major questions in cell biology. Here we look at some of the history of research devoted to the study of kinetochore-microtubule interaction and attempt to identify significant advances in the knowledge of the basic processes. Ultrastructural work has provided substantial insights into the structure of the kinetochore and associated microtubules during different stages of mitosis. Also, recent in-vivo studies have probed deep into the dynamics of kinetochore-attached microtubules suggesting possible models for the way in which kinetochores harness the capacity of microtubules to do work and turn it into chromosome motion. Much of the research in recent years suggests that indeed multiple mechanisms are involved in both formation of the k-fibre and chromosome motion. Thus, rather than moving to a unified theory, it has become apparent that most cell types have the capacity to build the spindle using multiple and probably redundant mechanisms.

Animals↗

Sustainability indicators as a communicative tool: building bridges in Pennsylvania.

Sustainability is a laudable goal, but difficult to define and to implement because of the complexity of interlinked human and natural systems, and the uncertainty inherent in such complex systems. Resilience shows promise as a relevant and measurable attribute of sustainability, which itself defies measurement. Identification and assessment of conditions that are desirable, as well as those that are undesirable, are necessary in order to determine both the degree of progress toward sustainability and the removal of impediments to such progress. Communications incident to the identification and selection of indicators of resilience and sustainability are of potentially greater value than the indicators themselves and so should be given explicit consideration in the design of the indicators development process. Moving towards sustainability requires an iterative, continuing (open-ended), collaborative process. Academic institutions can assist in this process through activities that connect across political, social and discipline boundaries. Boundary organizations are those that have achieved a level of trust among the relevant constituents to management of sustainability and can help convert academic findings that are objectively neutral into options and alternatives that may be politically and economically feasible. The Sustainable Pennsylvania Program is developing demonstration projects with both state and local governmental agencies with the objective of building both capacity and will for moving towards sustainability.

Communication↗

The reciprocal effects of leisure time activities and intellectual functioning in older people: a longitudinal analysis.

By using data from a representative longitudinal survey, the authors provide strong evidence that complex leisure time activities increase intellectual functioning for workers and nonworkers. Although the effects were relatively moderate, both the present article and its predecessor on the effects of paid work (C. Schooler. Mulatu, & Oates. 1999) showed that, even in old age, carrying out complex tasks has a positive effect on intellectual processes. In both cases, initially high levels of intellectual functioning led to high levels of environmental complexity, which in turn raised levels of intellectual functioning, thus providing a pathway contributing to the high correlation of intellectual functioning over a 20-year period in middle and late adulthood. The present findings indicate that even in old age carrying out substantively complex tasks builds the capacity to deal with the intellectual challenges such complex environments provide.

Adaptation, Psychological↗