Prevalence of Antimicrobial Resistance in Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli Isolates among Stillbirths and Deceased Under-Five Children in Sierra Leone: Data from the Child Health and Mortality Prevention Surveillance Sites from 2019 to 2022.

Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacae are associated with most nosocomial infections worldwide. Although gaps remain in the knowledge of their susceptibility patterns, these are in antimicrobial stewardship. This study aimed to describe antimicrobial susceptibility profiles of the above organisms isolated from postmortem blood from stillbirths and under-five children enrolled in the Child Health and Mortality Prevention Surveillance (CHAMPS) program in Sierra Leone. This was a surveillance study of bacteria isolates from postmortem blood cultures taken within 24 h of death from stillbirths and children aged 0-59 months between March 2019 and February 2022. This was followed by identification and antibiotic sensitivity testing using Becton Dickinson Phoenix M50 (USA). Descriptive analysis was used to characterize the isolates and their antimicrobial susceptibility patterns. Of 367 isolates, K. pneumoniae was the most frequently isolated organism (n = 152; 41.4%), followed by E. coli (n = 40; 10.9%) and E. cloacae (n = 35; 9.5%). Using BACTEC™ FX 40 (Franklin Lakes, NJ, USA), 367 isolates were identified from blood using bacteriological methods. Extended spectrum beta-lactamase (ESBL) was observed in 143 (94.1%) of K. pneumoniae isolates and 27 (65.5%) of E. coli isolates. Carbapenem-resistant organisms (CRO) were seen in 31 (20.4%) of K. pneumoniae and 5 (12.5%) of E. coli isolates. A multidrug resistance (MDR) pattern was most prevalent in E.cloacae (33/35; 94.3%), followed by K. pneumoniae (138/152; 90.8%). Our study showed a high prevalence of multidrug resistance among bacterial isolates in the catchment areas under surveillance by the CHAMPS sites in Sierra Leone.

Validating the CHAMPS Score: A Novel and Reliable Prognostic Score of Non-Variceal Upper Gastrointestinal Bleeding.

Introduction: The Charlson Comorbidity Index ≥2, in-Hospital onset, Albumin <2.5 g/dL, altered Mental status, Eastern Cooperative Oncology Group Performance status ≥2, Steroid use (CHAMPS) score is a novel and promising prognostic tool. We present an initial external validation of the CHAMPS score for predicting mortality in acute nonvariceal upper gastrointestinal bleeding (NVUGIB) across multiple clinical outcomes. Methods: A prospective cohort study was conducted on adult patients with NVUGIB admitted to the Department of Gastroenterology between November 2022 and June 2023. The CHAMPS score performance in predicting in-hospital outcomes was evaluated by employing area under the receiver operating characteristic (AUROC) curves, followed by a comparative analysis with five pre-existing scores. Results: A total of 140 patients were included in the study. The CHAMPS score showed its highest performance in predicting mortality rates (AUROC = 0.89), significantly outperforming the Glasgow-Blatchford Bleeding Score (GBS) as well as the Albumin level <3.0 mg/dL, International normalized ratio >1.5, altered Mental status, Systolic blood pressure ≤90 mmHg, and age >65 years (AIMS65) score (AUROC = 0.72 and 0.71, respectively; all p < 0.05). Subgroup analysis for bleeding-related and non-bleeding-related mortality further confirmed the robust predictive capability of the CHAMPS score (AUROC = 0.88 and 0.87, respectively). The CHAMPS score failed to predict rebleeding and intervention reliably, exhibiting AUROC values of 0.43 and 0.55, respectively. The optimal CHAMPS score cutoff value for predicting mortality was 3 points, achieving 100% sensitivity and 71.2% specificity. In the low-risk category defined by both CHAMPS and GBS scores, mortality and rebleeding rates were 0%. However, within the CHAMPS score-based low-risk group, 58.8% required intervention, contrasting with a 0% intervention rate for the GBS score-based low-risk group (GBS score ≤1). Conclusion: The CHAMPS score consistently demonstrated a robust predictive performance for mortality (AUROC > 0.8), facilitating the identification of high-risk patients requiring aggressive treatment and low-risk patients in need of localized treatment or safe discharge after successful bleeding control.

Validation of malaria-attributed deaths using verbal autopsy studies: a systematic review.

BACKGROUND: Malaria contributes substantially to the persistent burden of child deaths in sub-Saharan Africa. Accurate and comprehensive malaria mortality data are crucial to monitor the progress in reducing malaria incidence and mortality. Verbal Autopsy (VA) ascertains the cause of death despite its limitations leading to misclassification errors. Minimally Invasive Tissue Sampling (MITS) is being conducted in some settings as an alternative to Complete Diagnostic Autopsy (CDA). The present study examines the validity of malaria-related deaths comparing VA diagnoses with those obtained through MITS and/or CDA. METHODS: A comprehensive literature search for original studies in English language using Ovid MEDLINE, Ovid Embase, CINAHL via EBSCO, Scopus, The Cochrane Library via Wiley, Google Scholar and searching the MITS Surveillance Alliance papers was carried out. The reference period was January 1, 1990-March 31, 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted. RESULTS: Among 71 articles identified in the databases, 21 matched the eligibility criteria. Qualitative syntheses showed that malaria Cause Specific Mortality Fractions (CSMFs) across various studies ranged from 2 to 31%. Plasmodium falciparum was mostly responsible for these deaths and the most common complications were anaemia and cerebral malaria. The sensitivity and specificity of the VA validation studies ranged from 18.4% to 33% and from 86.6% to 97%, respectively, and there was a high level of misclassification for both InSilico and Expert Algorithm VA for malaria compared to MITS. The overall concordance rates between MITS and CDA diagnoses ranged from 68 to 90%, with the highest concordance seen in deaths due to infectious diseases and malignant tumours. Clinical data increased diagnostic coincidence between MITS blind to clinical data and the gold standard CDA by 11%. CONCLUSIONS: The comprehensive review finds that MITS demonstrated better accuracy compared to VA in diagnosing malaria-attributed deaths, particularly in hospital settings. The high specificity of malaria in VA diagnosis suggests population-based estimates of the proportion of deaths due to malaria are broadly plausible.

Same, Same but Different: Comparing Program Fidelity at Early Versus Late Adopters of a Successful Long-Term School-Based Physical Activity Intervention.

Schools have been identified as a promising setting for promoting physical activity (PA). Yet, to realize changes at the population level, successful school-based PA programs need to go to scale. The Svendborgproject is an effective school-based program promoting additional physical education (PE) lessons. The aim of this study is to determine program fidelity across different school groups, representing early and late adopters of the Svendborgproject, and how these are adapting the intervention. Three different school groups were identified, covering the original intervention schools and two groups of late adopters consisting of four former control schools, and five normal schools without any previous connection to the program. A PE teacher questionnaire (n = 122) was used to determine school fidelity. The results show that, while the original intervention schools have implemented the program with the highest fidelity, all schools have implemented the program with medium to high fidelity. It is suggested that having front-runner schools achieving early success with the program both strengthens political project support and provides strategies to back late adopters' implementation of the program. Furthermore, results from the current study suggest that continual promotion of the program by school heads is less important if support is established at the structural and organizational macro level. Finally, we highlight the importance of scaling up organizational capacity when scaling up program reach to assure a workable balance between fidelity and improving the fit to specific contexts.

Physical activity measurement in older adults: Wearables versus self-report.

Physical activity (PA) is associated with preserved age-related body and brain health. However, PA quantification can vary. Commercial-grade wearable monitors are objective, low burden tools to capture PA but are less well validated in older adults. Self-report PA questionnaires are widely accepted and more frequently used but carry inherent limitations. We aimed to compare these commonly used PA measures against one another and examine their convergent validity with a host of relevant outcomes. We also examined the factors that drive differences in PA self-reporting styles in older adults. 179 older adults completed 30-day Fitbit Flex2™ monitoring and reported PA levels via two widely used PA questionnaires: PASE and CHAMPS-METs (metabolic expenditure calories burned). Participants also completed measures of cardiometabolic (hypertension diagnosis, resting heart rate, A1C levels), cognitive (memory, processing speed, executive functioning), and brain MRI (medial temporal lobe volume) outcomes. The discrepancy between objective Fitbit monitoring and self-reported PA was evaluated using a sample-based z difference score. There were only modest relationships across all PA metrics. Fitbit step count demonstrated a stronger association with the PASE, whereas Fitbit calories burned was more strongly associated with CHAMPS-MET. Fitbit outcomes had more consistent convergence with relevant outcomes of interest (e.g., cardiometabolic and brain health indices) when compared to subjective measures; however, considerable heterogeneity within these associations was observed. A higher degree of overreporting was associated with worse memory and executive performances, as well as hypertension diagnoses. We build on prior findings that wearable, digital health indicators of PA demonstrate greater construct validity than self-report in older adults. We further show important clinical features (e.g., poorer cognitive status) of older adults that could contribute to a higher level of overreporting on self-report measures. Characterization of what PA measures truly operationalize will help elucidate relationships between most relevant facets of PA and outcomes of interest.

The technologically-mediated self: reflections on the container and field of telecommunications.

This paper contains reflections on the use of the imagination in technologically-mediated therapy and analysis. As part of the individuation process the psyche is seen as needing to adapt to new technological ways of communicating. The notion of a technologically-mediated self is posited describing a self which can only be apprehended through, and by, the use of telecommunications. This self is seen as identical to the in-person self, a subset, or superset of it. There is a revisioning of our notions of the container and the field in this work performed through technological-mediation. The need to engage the imagination in approaching this kind of work is emphasized in order to create an imaginal play-space in which the body will be deeply affected. Some thoughts on how the process of individuation might look through such analytic work is presented.

Cet article contient des réflexions sur l'utilisation de l'imagination dans la thérapie et l'analyse pratiquées par la médiation de la technologie. En tant que partie intégrante du processus d'individuation, la psyché est considérée comme devant s'adapter à de nouvelles façons de communiquer, basées sur la technologie. La notion d'un soi atteint par la médiation de la technologie est postulée, un soi qui ne peut être appréhendé que par le biais de l'utilisation des télécommunications. Ce soi est considéré comme étant identique au soi dans la personne; un sous-ensemble, ou un sur-ensemble. L'article présente une révision de nos notions de contenant et de champ quand on travaille avec la médiation de la technologie. Il souligne le besoin de mobiliser l'imagination quand on aborde ce genre de travail afin de créer un espace imaginal de jeu dans lequel le corps sera profondément affecté. Il propose quelques pensées sur comment le processus d'individuation pourrait se présenter au travers d'un tel travail analytique.

El presente trabajo contiene reflexiones sobre el uso de la imaginación en terapia y análisis mediado por la tecnología. Como parte del proceso de individuación, la psique necesita adaptarse a nuevos modos tecnológicos de comunicación. Se propone la noción de un self mediado-tecnológicamente, al describir a un self que solamente puede ser aprehendido a través y por el uso de las telecomunicaciones. Este self es considerado como idéntico al self presencial, una parte o una versión mayor del mismo. Se presenta una revisión de nuestras nociones acerca del campo y del espacio de contención en este trabajo realizado a través de la mediación tecnológica. Se enfatiza la necesidad de comprometer a la imaginación al abordar esta forma de trabajo, para crear un espacio de juego-imaginal, en el cual el cuerpo estará profundamente afectado. Se presentan algunas reflexiones acerca de cómo podría mirarse el proceso de individuación a través de dicho trabajo.

A simple prediction score for in-hospital mortality in patients with nonvariceal upper gastrointestinal bleeding.

BACKGROUND: No prediction scores for the mortality of both inpatients and outpatients who developed nonvariceal upper gastrointestinal bleeding (UGIB) without endoscopic findings have been established. We aimed to derive and validate a novel prediction score for in-hospital mortality. METHODS: We conducted a three-stage, multicenter retrospective study. In the derivation stage, patients with nonvariceal UGIB at six institutions were enrolled to derive the prediction score by logistic regression analysis. External validation of the score was performed to analyze discrimination by patients at six other institutions. Then the performance of this score was compared with that of four existing scores. RESULTS: We enrolled 1380 and 825 patients in the derivation and validation cohorts, respectively. A prediction score (CHAMPS-R Score) comprising seven variables (Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroids, and rebleeding) with equal-weight scores was established, with high discriminative ability in both derivation and validation cohorts (c statistic, 0.91 and 0.80, respectively). When rebeeding was excluded from the score (an onset model; CHAMPS Score), this score also achieved high discriminative ability (c statistic, 0.90 and 0.81, respectively). The prediction scores had significantly higher discriminative ability than the Glasgow Blatchford Score, AIMS65, ABC Score, and clinical Rockall Score in both cohorts (all, p < 0.05). CONCLUSIONS: We derived and externally validated prediction scores for in-hospital mortality in patients with nonvariceal UGIB. The CHAMPS Score might be optimal for managing such patients. Its mobile application is freely available ( https://apps.apple.com/app/id1565716902 for iOS and https://play.google.com/store/apps/details?id=hatta.CHAMPS for Android).

Diferenças / Differences / Diferencias / Différences

Esta apresentação - não apresentada, por causa da irrupção da atual pandemia - pretende resgatar a inquietação que está na origem da teoria dos campos: a de que as distintas escolas de psicanálise talvez possuam uma função terapêutica comum. Para isso, esboça um estudo sobre a noção de diferença.

This presentation - not presented, due to the outbreak of the current pandemic - aims to rescue the suspicion that is at the origin of the Multiple Fields Theory: that the different schools of psychoanalysis may have a common therapeutic function. For that, it outlines a study on the notion of difference.

Esta presentación, no presentada debido al brote de la pandemia actual, tiene la intención de rescatar la inquietud que es el origen de la Teoría de los Campos: que las diferentes escuelas de psicoanálisis pueden tener una función terapéutica común. Para eso, delinea un estudio sobre la noción de diferencia.

Cet exposé - dont l'exposition est empêchée par la pandémie actuelle - compte récupérer la préoccupation qui est à l'origine de la Théorie des Champs: celle selon laquelle les différentes écoles de psychanalyse peuvent avoir une fonction thérapeutique en commun. Pour cela, on élabore une étude sur la notion de différence.

A comparison of MITS counseling and informed consent processes in Pakistan, India, Bangladesh, Kenya, and Ethiopia.

Globally, more than 5 million stillbirths and neonatal deaths occur annually. For many, the cause of death (CoD) is unknown. Minimally invasive tissue sampling (MITS) has been increasingly used in postmortem examinations for ascertaining the CoD in stillbirths and neonates. Our study compared the counseling and consent methods used in MITS projects in five countries in Africa and south Asia. Key informant interviews were conducted with researchers to describe the characteristics and backgrounds of counselors, the environment and timing of consent and perceived facilitators and barriers encountered during the consent process. Counselors at all sites had backgrounds in social science, psychology and counseling or clinical expertise in obstetrics/gynecology or pediatrics. All counsellors received training about techniques for building rapport and offering emotional support to families; training duration and methods differed across sites. Counselling environments varied significantly; some sites allocated a separate room, others counselled families at the bedside or nursing stations. All counsellors had a central role in explaining the MITS procedure to families in their local languages. Most sites did not use visual aids during the process, relying solely on verbal descriptions. In most sites, parents were approached within one hour of death. The time needed for decision making by families varied from a few minutes to 24 h. In most sites, extended family took part in the decision making. Because many parents wanted burial as soon as possible, counsellors ensured that MITS would be conducted promptly after receiving consent. Barriers to consent included decreased comprehension of information due to the emotional and psychological impact of grief. Moreover, having more family members engaged in decision-making increased the complexity of counselling and achieving consensus to consent for the procedure. While each site adapted their approach to fit the context, consistencies and similarities across sites were observed.

Interventions Addressing Vision, Visual-perceptual Impairments Following Acquired Brain Injury: A Cross-sectional Survey.

BACKGROUND.: The existing literature on the effectiveness of interventions targeting vision, visual-perceptual impairments following acquired brain injury (ABI) is scarce and unlinked to occupational performance. PURPOSE.: To explore current occupational therapy practice in vision-rehabilitation among adults with ABI in Canada, and to determine the evidence-practice gaps. METHODS.: An online survey was made available through the Canadian Association of Occupational Therapists (CAOT) website, and disseminated to seven public healthcare institutions in Quebec. The survey collected respondent demographic information, and the types and frequency of treatments delivered. Descriptive statistics were conducted to determine interventions' frequency. Participant comments were collected and grouped into recurring themes. FINDINGS.: Over half (55%) of respondents regularly use evidence-based interventions when addressing visual acuity (VA) and visual field (VF) deficits, but only very few (3%) use it when dealing with oculomotor function and visual stress impairments. IMPLICATIONS.: Results gave a glimpse of interventions used and suggested the need for further research in vision rehabilitation.

Campos de ação estratégica e os recursos de poder do sistema de gestão de recuperação de direitos na bacia do Rio Doce / Strategic fields of action and power resources of the rights recovery management system in the Rio Doce basin / Campos estratégicos de acción y recursos de poder del sistema de gestión de recuperación de derechos en la cuenca del Río Doce / Les champs d'action stratégique et les ressources de puissance du système de gestion du recouvrement des droits dans le bassin du Rio Doce

O rompimento da barragem de Fundão, pertencente às empresas Samarco, BHP Billiton e Vale provocou o maior desastre socioambiental do país. A lama de rejeitos de minérios de percorreu a extensão do Rio Doce até o mar, causando diversos danos ambientais, sociais, econômicos e culturais. Este estudo analisa as estratégias de ação das comunidades atingidas no território capixaba, e as instâncias do sistema de governança do desastre para compreender quais os recursos e interações potencialmente avançam na luta por seus direitos. Em vista disso, o artigo explora aspectos jurídicos do desastre através dos dispositivos extrajudiciais que organizam a gestão da recuperação e reparação dos danos. A teoria dos campos é operacionalizada para compreender o cenário de negociação, estratégias de cooperação, coalização e contestação que foi desencadeado entre os atingidos, autoridades e agentes do mercado. A investigação foi realizada através do estudo de caso, grupos de discussão, e observação participante da tecnologia social Com Rio Com Mar Opinião Popular criada como apoio e suporte aos atingidos, e da atuação da Defensoria Pública do Estado do Espírito Santo.

The breach of the Fundão dam, belonging to Samarco, BHP Billiton and Vale companies, caused the biggest social and environmental disaster in the country. The ore tailings sludge ran the length of the Rio Doce to the sea, causing various environmental, social, economic and cultural damages. This study analyzes the strategies of action of communities affected in the state of Espírito Santo, and the instances of the disaster governance system to understand which resources and interactions potentially advance in the struggle for their rights. In face of the article explores the legal aspects of the disaster through the extrajudicial arrangements that organize the management of recovery and damage repair. Field theory is operationalized to understand the negotiation scenario, cooperation strategies, coalition and contestation that was unleashed among the affected, authorities and market agents. The investigation was conducted through case study, discussion groups, and participant observation of the social technology Com Rio Com Mar Popular Opinion created as support and support to those affected, and the performance of the Public Defender's Office of the State of Espírito Santo.

La ruptura de la presa Fundão, perteneciente a las compañías Samarco, BHP Billiton y Vale, causó el mayor desastre social y ambiental en el país. El lodo de relaves minerales se extendía a lo largo del río Doce hasta el mar, causando varios daños ambientales, sociales, económicos y culturales. Este estudio analiza las estrategias de acción de las comunidades afectadas en el estado de Espírito Santo, y las instancias del sistema de gobernanza de desastres para comprender qué recursos e interacciones potencialmente avanzan en la lucha por sus derechos. En vista de esto, el artículo explora los aspectos legales del desastre a través de los arreglos extrajudiciales que organizan la gestión de la recuperación y reparación de daños. La teoría de campo se operacionaliza para comprender el escenario de negociación, las estrategias de cooperación, la coalición y la contestación que se desató entre los afectados, las autoridades y los agentes del mercado. La investigación se realizó a través de un estudio de caso, grupos de discusión y observación participante de la tecnología social. Opinión popular creada por Com Rio Com Mar como apoyo y apoyo a los afectados, y el desempeño de la Oficina del Defensor Público del Estado de Espírito Santo.

La rupture du barrage de Fundão, appartenant aux entreprises Samarco, BHP Billiton et Vale, a provoqué le plus grand désastre socio-environnemental du pays. La boue de rebuts de minerais a parcouru l'étendue du Rio Doce jusqu'à la mer, causant divers dommages environnementaux, sociaux, économiques et culturels. Cette étude analyse les stratégies d'action des communautés touchées sur le territoire capixaba, et les instances du système de gouvernance du désastre pour comprendre quelles ressources et interactions pourraient progresser dans la lutte pour leurs droits. Cet article explore donc les aspects juridiques de la catastrophe à travers les dispositifs extrajudiciaires qui organisent la gestion de la réparation et de la réparation des dommages. La théorie des champs est mise en place pour comprendre le scénario de négociation, les stratégies de coopération, la coercition et la contestation qui a été déclenchée parmi les touchés, les autorités et les acteurs du marché. La recherche a été réalisée par l'étude de cas, des groupes de discussion, et l'observation participante de la technologie sociale Com Rio Com Mar Opinião Popular créée comme soutien et soutien aux touchés, et de l'action du Défenseur Public de l'Etat de l'Esprit Saint.

Overview and Development of the Child Health and Mortality Prevention Surveillance Determination of Cause of Death (DeCoDe) Process and DeCoDe Diagnosis Standards.

Mortality surveillance and cause of death data are instrumental in improving health, identifying diseases and conditions that cause a high burden of preventable deaths, and allocating resources to prevent these deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) network uses a standardized process to define, assign, and code causes of stillbirth and child death (<5 years of age) across the CHAMPS network. A Determination of Cause of Death (DeCoDe) panel composed of experts from a local CHAMPS site analyzes all available individual information, including laboratory, histopathology, abstracted clinical records, and verbal autopsy findings for each case and, if applicable, also for the mother. Using this information, the site panel ascertains the underlying cause (event that precipitated the fatal sequence of events) and other antecedent, immediate, and maternal causes of death in accordance with the International Classification of Diseases, Tenth Revision and the World Health Organization death certificate. Development and use of the CHAMPS diagnosis standards-a framework of required evidence to support cause of death determination-assures a homogenized procedure leading to a more consistent interpretation of complex data across the CHAMPS network. This and other standardizations ensures future comparability with other sources of mortality data produced externally to this project. Early lessons learned from implementation of DeCoDe in 5 CHAMPS sites in sub-Saharan Africa and Bangladesh have been incorporated into the DeCoDe process, and the implementation of DeCoDe has the potential to spur health systems improvements and local public health action.

Mortality Surveillance Methods to Identify and Characterize Deaths in Child Health and Mortality Prevention Surveillance Network Sites.

Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through comprehensive mortality surveillance, utilizing minimally invasive tissue sampling (MITS), postmortem laboratory and pathology testing, verbal autopsy, and clinical and demographic data. CHAMPS sites have established facility- and community-based mortality notification systems, which aim to report potentially eligible deaths, defined as under-5 deaths and stillbirths within a defined catchment area, within 24-36 hours so that MITS can be conducted quickly after death. Where MITS has been conducted, a final cause of death is determined by an expert review panel. Data on cause of death will be provided to local, national, and global stakeholders to inform strategies to reduce perinatal and childhood mortality in sub-Saharan Africa and South Asia.

Pathology and Telepathology Methods in the Child Health and Mortality Prevention Surveillance Network.

This manuscript describes the Child Health and Mortality Prevention Surveillance (CHAMPS) network approach to pathologic evaluation of minimally invasive tissue sampling (MITS) specimens, including guidelines for histopathologic examination and further diagnostics with special stains, immunohistochemistry, and molecular testing, as performed at the CHAMPS Central Pathology Laboratory (CPL) at the Centers for Disease Control and Prevention, as well as techniques for virtual discussion of these cases (telepathology) with CHAMPS surveillance locations. Based on review of MITS from the early phase of CHAMPS, the CPL has developed standardized histopathology-based algorithms for achieving diagnoses from MITS and telepathology procedures in conjunction with the CHAMPS sites, with the use of whole slide scanners and digital image archives, for maximizing concurrence and knowledge sharing between site and CPL pathologists. These algorithms and procedures, along with lessons learned from initial implementation of these approaches, guide pathologists at the CPL and CHAMPS sites through standardized diagnostics of MITS cases, and allow for productive, real-time case discussions and consultations.

Implementation of a successful long-term school based physical education intervention: Exploring provider and programme characteristics.

There is an ongoing need for research focusing on how to implement physical activity programmes into a school setting. This includes documentation of the extent to which programmes are compatible with the basic views of providers and their local practices. The present study explores the Svendborgproject - a programme tripling the amount of physical education in six public schools, sustaining it for 10-years and documenting a decreased incidence of overweight, obesity and cardiovascular risk factors. The aim was to analyse provider and programme characteristics of the Svendborgproject to gain insights into providers motives for adopting, implementing, and maintaining the programme. Six school heads and six teachers were interviewed to explore how they perceived programme compatibility to their school's practice and their own role as providers. Both teachers and school heads found the additional lessons a valuable asset that fitted existing school values and priorities. Additionally, physical education teachers participated in a course providing new perspectives and teaching methods that aided the implementation of the programme. Lastly, school heads stressed that implementation fidelity was heavily dependent on the dedication of physical education teachers and on having simple programme requirements that made it clear what could be expected of the programme.

Using the RE-AIM framework to evaluate a school-based municipal programme tripling time spent on PE.

Documenting the implementation of effective real-world programmes is considered an important step to support the translation of evidence into practice. Thus, the aim of this study was to identify factors influencing the adoption, implementation and maintenance of the Svendborgproject (SP) - an effective real-world programme comprising schools to implement triple the amount of physical education (PE) in pre-school to sixth grade in six primary schools in the municipality of Svendborg, Denmark. SP has been maintained for ten years and scaled up to all municipal schools since it was initiated in 2008. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework (RE-AIM) was applied as an analytic tool through a convergent mixed method triangulation design. Results show that SP has been implemented with high fidelity and become an established part of the municipality and school identity. The successful implementation and dissemination of the programme has been enabled through the introduction of a predominantly bottom-up approach combined with simple non-negotiable requirements. The results show that this combination has led to a better fit of programmes to the individual school context while still obtaining high implementation fidelity. Finally, the early integration of research has legitimated and benefitted the programme.

Implementation of triple the time spent on physical education in pre-school to 6th grade: A qualitative study from the programme managers' perspective.

Schools constitute an important arena for promoting physical activity. However, school-based programmes often face implementation challenges, and the identification of factors influencing the implementation process is considered important in order to secure the effectiveness of future interventions. The aim of this study was to identify factors influencing the various implementation stages during the initial years of a programme tripling the amount of physical education at the primary school level. Document analysis of publicly available programme descriptions and meeting minutes, were conducted. Document analysis was complemented by two semi-structured group interviews with main programme managers to gather in-depth programme experiences and perspectives. Results show that early involvement of schools may ensure the best possible match between programmes and the needs and resources of schools, and that an ongoing shared partnership may help programme managers address program challenges in early stages. It seems that predetermined core elements in programmes are essential. At the same time programmes must be flexible enough for adaptation to individual school contexts. Finally, the implementation of triple the amount of physical education, is supported by teachers receiving a professional development course focusing on how to organise outdoor physical education in different seasons and weather conditions.

Patterns of physical activity in sedentary older individuals with type 2 diabetes.

BACKGROUND: The Community Healthy Activities Model Program for Seniors (CHAMPS) survey, summarized into weekly caloric expenditures, is a common physical activity (PA) assessment tool among older adults. Specific types of PA reported in the CHAMPS have not been systematically analyzed. We applied latent class analysis to identify the patterns of PA among sedentary older adults with diabetes reported in the CHAMPS survey. METHODS: Latent class models of PA were identified using the CHAMPS survey data reported by 115 individuals aged ≥60 years with type 2 diabetes whom volunteered for a clinical study of PA. Multinomial logistic regression was used to assess independent predictors of a specific latent class, including age, sex, and performance in physical function tests. RESULTS: Ninety-three percent of the participants were classified into 3 latent classes. Participants in latent class 1 (60.9%) primarily reported domestic-focused activities. Participants in latent class 2 and 3 (19.5% and 19.6%, respectively) reported domestic-focused activities, in addition to leisure-time physical activities and structured exercise activities. Latent class 1, with more women than men (73% vs.27%), had the lowest caloric expenditure, whereas class 3, with fewer women than men (28% vs. 72%), had the highest caloric expenditure (all p < 0.001). Latent class 2 had the fastest Timed-Up- and Go (7.65 ± 1.28 s; p = 0.03). CONCLUSIONS: Individual PA response in CHAMPS can be categorized using latent class models into meaningful patterns which can inform PA interventions. Customized PA programs should consider the heterogeneity of the activities among sedentary older adults. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00344240; retrospectively registered 23 June 2006.

Psicanálise, ficção e cura: entre a Teoria dos Campos e a Teoria do Efeito Estético / Psychanalyse, fiction et guérison: entre la Théorie des Champs et la Théorie de l'Effet Esthétique / El psicoanálisis, la ficción y la cura: entre la Teoría de los Campos y Teoría del Efecto Estético / Psychoanalysis, fiction, and cure: between Fields Theory and Theory of Aesthetic Response

A intenção deste trabalho é propor uma reflexão sobre a potência da literatura, a necessidade humana de ficção a partir de um primeiro diálogo entre a Teoria dos Campos, de Fabio Herrmann, e a Teoria do Efeito Estético, de Wolfgang Iser. Procura-se esboçar algumas articulações entre o estatuto atribuído à ficção na obra de Herrmann e a discussão na obra de Iser sobre a ficção e o imaginário que desemboca em uma antropologia literária. Trata-se de um trabalho inicial que aponta para futuras pesquisas a partir da ideia de Herrmann da literatura como análoga à psicanálise, por isso, propõe-se a Teoria do Efeito Estético como possibilidade teórica para a fundamentação dessa ideia.

Le but de cet article est de proposer une réflexion sur le pouvoir de la littérature, le besoin humain de fiction à partir d'un premier dialogue entre la Théorie des Champs développé par Fabio Herrmann et la Théorie de l'Effet Esthétique développée par Wolfgang Iser. Nous voulions tirer des liens entre le statut donné à la fiction dans l'œuvres de Herrmann et la discussion sur les travaux de Iser à propos de la fiction et l'imaginaire qui se jette dans une anthropologie littéraire. Cet article, qui pointe au début de la recherche future de l'idée de Herrmann sur la littérature comme un analogue de la psychanalyse, il est proposé, par conséquent, la Théorie de l'Effet Esthétique qu'une possibilité théorique qui sous-tend cette idée.

La intención de este trabajo es proponer una reflexión sobre el poder de la literatura, la necesidad humana de ficción desde un primer diálogo entre la Teoría de los Campos, de Fabio Herrmann, y Teoría del Efecto Estético, de Wolfgang Iser. Se pretende establecer algunas conexiones entre el estado dado a la ficción en la obra de Herrmann y el debate sobre la ficción y la imaginación en el trabajo de Iser que desemboca en una antropología literaria. Es un trabajo inicial que apunta a estudios futuros de la idea de Herrmann en la literatura como un análogo del psicoanálisis, por ello, propone la Teoría del Efecto Estético como una posibilidad teórica para el razonamiento de esta idea.

This study intends to propose a reflection on the power of literature and the human need for fiction based on a first dialogue between Fabio Herrmann's Fields Theory and Wolfgang Iser's Theory of Aesthetic Response. We seek to outline some links between the status assigned to fiction in Herrmann's work and the discussion in Iser's work about fiction and imagination, which leads to a literary anthropology. This is an initial study that points to future research from Herrmann's idea of literature as an analogue of psychoanalysis. We propose, therefore, that the Theory of Aesthetic Response is a theoretical possibility for grounding that idea.