Impact evaluation of a community nutrition and livelihood program on child nutrition in rural Bangladesh.

Given the high prevalence of child undernutrition in Bangladesh, multi-sectoral approaches involving livelihood promotion have potential to mitigate the burden of undernutrition. This study examined the impact of an economic development (ED) program providing poultry assets, gardening skills and saving training added to the Positive Deviant (PD)/Hearth program (PDH/ED), compared to PD/Hearth only (PDH). A total of 1029 children who attended PD/Hearth sessions in September-November 2018 at 6-13 months of age were enrolled in the cohort study in July-August 2019. The cohort, comprised of 532 children in the PDH/ED group and 593 children in the PDH group, was reassessed in November 2020. The program impact on child nutrition, food security, crop production, dietary quality and household income was estimated using a difference-in-differences approach accounting for the sociodemographic differences between PDH/ED and PDH groups. Compared to the PDH group, the PDH/ED group showed increases in child dietary diversity score (DDS) (+0.32), child minimum dietary diversity (13.7 percentage points [pp]), and maternal DDS (+0.28) (all p < 0.05). From 2019 to 2020, the PDH/ED households improved food security by 12.6 pp and diversified crop production (bananas (9.7 pp), papaya (11.1 pp), carrots (3.8 pp) and lemons (5.9 pp)), and increased the proportion of annual income ≥60,000 Taka by 12.4 pp and last month income ≥5000 Taka by 7.8 pp, compared to PDH group (all p < 0.05). However, there was no impact on child nutritional status, morbidity, livestock ownership and total annual/last income. Incorporating an ED program into nutrition programming could benefit food security and dietary diversity in rural Bangladesh.

The teamwork structure, process, and context of a paediatric cardiac surgery team in Mongolia: A mixed-methods approach.

INTRODUCTION: Effective teamwork in paediatric cardiac surgery is known to improve team performance and surgical outcomes. However, teamwork in low- and middle-income countries (LMICs), including Mongolia, is understudied. We examined multiple dimensions of teamwork to inform a team-based training programme to strengthen paediatric cardiac surgical care in Mongolia. METHODS: We used a mixed-methods approach, combining social network analysis and in-depth interviews with medical staff, to explore the structure, process, quality, and context of teamwork at a single medical centre. We conceptualised the team's structure based on communication frequency among the members (n = 24) and explored the process, quality, and context of teamwork via in-depth interviews with select medical staff (n = 9). RESULTS: The team structure was highly dense and decentralised, but the intensive care unit nurses showed high betweenness-centrality. In the quality and process domain of teamwork, we did not find a regular joint decision-making process, leading to the absence of common goals among the team members. Although role assignment among the medical staff was explicit, those strictly defined roles hindered active communication about patient information and responsibility-sharing. Most interviewees did not agree with the organisational policies that limited discussions among team members; therefore, medical staff continued to share training and work experiences with each other, leading to strong and trustworthy relationships. CONCLUSION: The findings of this study underscore the importance of well-structured and goal-oriented communication between medical staff, as well as the management of the quality of collaboration within a team to increase teamwork effectiveness in paediatric cardiac surgery teams in LMICs.

Combinations of Conditions for Network Effectiveness: A Fuzzy-Set Qualitative Comparative Analysis of 37 International Development Intervention Cases.

Most international development projects that aim to eradicate poverty and improve the quality of life of people in low- and middle-income countries are implemented through a collaborative network of multiple parties, including non-governmental organizations (NGOs). However, how network effectiveness in international development projects can be achieved remains unclear. Using fuzzy-set qualitative comparative analysis, this study explores the causal conditions of network effectiveness of 37 international development projects implemented by South Korean NGOs based on a theoretical lens of collaborative networks. Findings revealed two causal configurations for network effectiveness. Even under a lack of network management capacity and unintegrated networks, or under resource deficiency and lack of network management capacity, high-level local capacity or high-quality collaboration among partners was shown to produce network effectiveness. An in-depth analysis of two cases with successful network effectiveness was also conducted to achieve a more thorough and comprehensive understanding of the causal conditions. The findings suggest practical solutions to manage collaborative networks and compensate for deficiencies of diverse conditions to improve network effectiveness.

Design of a collaborative monitoring and evaluation system for a community-based nutrition project in rural Bangladesh.

Poor diet and undernutrition are common among children living in Bangladesh. To promote appropriate complementary feeding of young children, an economic development (ED) program involving income-generating asset transfer was implemented alongside a social and behavior change (SBC) program. This paper introduces a collaborative monitoring and evaluation (M&E) system in which diverse collaborators ("research group", "implementation team", and "coordinators") facilitate M&E data acquisition by leveraging their comparative advantages. The implementation team built a monitoring system to track the ED (n = 2960) and SBC participants (n=∼10,000) over 12 months. Based on the baseline design and the monitoring records, the collaborators planned an impact evaluation introducing a quasi-experimental design using two cross-sectional surveys and a prospective cohort survey of child feeding and nutritional status. Using various data sources generated from the M&E system, the collaborators will also reveal the program impact pathway through which each intervention component is delivered, received, and utilized alongside the context-specific facilitators and barriers, including the programs' uptake. The collaborative M&E system enables the sharing of program goals, strengthens collaborators' commitment to the program, and extends the understanding of the program's progress and evaluation activities.

Evaluation of a Ten-Year Team-Based Collaborative Capacity-Building Program for Pediatric Cardiac Surgery in Uzbekistan: Lessons and Implications.

Background: Most children who have congenital heart disease in low- and middle-income countries (LMICs), including Uzbekistan, do not receive adequate and timely pediatric cardiac surgical care. To strengthen the surgical capacity of a local pediatric cardiac surgery team in Tashkent, Uzbekistan, the JW LEE Center for Global Medicine at Seoul National University College of Medicine has developed a team-based training program and has been collaboratively conducting surgeries and care in order to transfer on-site knowledge and skills from 2009 to 2019. Objectives: To evaluate the long-term effects of the collaborative program on the cardiac surgical capacity of medical staff (teamwork, surgical complexity, and patients' pre-surgical weights) as well as changes in the lives of the patients and their families. To derive lessons and challenges for other pediatric cardiac surgical programs in LMICs. Methods: To assess the effects of this ten-year long program, a mixed-methods design was developed to examine the trend of surgical complexity measured by Risk Adjustment for Congenital Heart Surgery 1 score (RACHS-1) and patients' pre-surgical weights via medical record review (surgical cases: n = 107) during the decade. Qualitative data was analyzed from in-depth interviews (n = 31) with Uzbek and Korean medical staff (n = 10; n = 4) and caregivers (n = 17). Findings: During the decade, the average RACHS-1 of the cases increased from 1.9 in 2010 to 2.78 in 2019. The average weight of patients decreased by 2.8 kg from 13 kg to 10.2 kg during the decade. Qualitative findings show that the surgical capacity, as well as attitudes toward patients and colleagues of the Uzbek medical staff, improved through the effective collaboration between the Uzbek and Korean teams. Changes in the lives of patients and their families were also found following successful surgery. Conclusions: Team-based training of the workforce in Uzbekistan was effective in improving the surgical skills, teamwork, and attitudes of medical staff, in addition, a positive impact on the life of patients and their families was demonstrated. It can be an effective solution to facilitate improvements in pediatric cardiovascular disease in LMICs if training is sustained over a long period.

Effects of ginsenoside on pacemaker potentials of cultured interstitial cells of Cajal clusters from the small intestine of mice.

Ginsenoside, one of the active ingredients of Panax ginseng, has a variety of physiological and pharmacological actions in various organs. However, little is known about the effects of ginsenosides on gastrointestinal (GI) motility. We studied the modulation of pacemaker potentials by ginsenoside in the interstitial cells of Cajal (ICCs) using the whole-cell patch clamp technique in the current clamp mode. Among ginsenosides, we investigated the effects of ginsenoside Rb1, Rg3 and Rf. While externally applied Rb1 and Rg3 had no effects on pacemaker potentials, Rf caused membrane depolarization. The application of flufenamic acid or niflumic acid abolished the generation of pacemaker potentials and inhibited the Rf-induced membrane depolarization. Membrane depolarization induced by Rf was not inhibited by intracellular application of guanosine 5'-[ß-thio]diphosphate trilithium salt. Pretreatment with a Ca(2+)-free solution, thapsigargin, a Ca(2+)-ATPase inhibitor of the endoplasmic reticulum, U-73122, a phospholipase C inhibitor, or 2-APB, an IP3 receptor inhibitor, abolished the generation of pacemaker potentials and suppressed Rfinduced actions. However, treatment with chelerythrine and calphostin C, protein kinase C inhibitors, did not block Rf-induced effects on pacemaker potentials. These results suggest that ginsenoside Rf modulates the pacemaker activities of ICCs and thereby regulates intestinal motility.

High-speed atomic force microscope lithography using a piezo tube scanner driven by a sinusoidal waveform.

Improving the throughput of atomic force microscope (AFM) lithography is an important success factor for employing it in nanolithography applications. The conventional motion of the AFM tube scanner is usually driven by triangular-shaped signals, but it is limited in speed due to mechanical instability of the scanner at the turning points. Here, we show that high-speed lithography is achievable using not only a piezo tube driven by a sinusoidal waveform signal but also highly sensitive noble organic resists including a photo acid generator. Cross-linked polymer nanostructures applying sinusoidal waveform driving have also shown improvements in the linearity and uniformity of line patterns.