Ized by weak communal goals.Alcohol Clin Exp Res. Author manuscript

Ized by weak communal goals.Alcohol Clin Exp Res. Author manuscript; available in PMC 2016 December 01.Meisel and ColderPageInjunctive Pan-RAS-IN-1MedChemExpress Pan-RAS-IN-1 NormsAuthor Manuscript Author Manuscript Author Manuscript Author ManuscriptInjunctive Norms X Communal Goals As depicted in Panel C of Figure 1, 6th grade injunctive norms were associated with increased probability of alcohol in 7th grade alcohol use for adolescents with low (OR=2.91, p<.05), but not high (OR=0.76, p>.05) levels of communal goals. Moving to later adolescence, high levels of injunctive norms in 9th grade were associated with increased probability of alcohol use in 10th grade for adolescents with both low (OR=1.80, p>.05) and high (OR=2.68, p>.05) levels of communal goals. This pattern suggests that injunctive norms take on increasing importance in later adolescence PD150606 mechanism of action across the spectrum of communal goals. These findings provide partial support for the hypothesized interaction between injunctive norms, high communal goals and grade but also contradict our hypotheses such that high levels of injunctive norms and low levels of communal goals predicted higher levels of alcohol use in later adolescence.DiscussionAlthough social norms are robust predictors of adolescent alcohol use (Borsari and Carey, 2001; Perkins, 2002), theoretical formulations suggest that the impact social norms have on behavior varies depending on their salience. Few studies have examined potential mechanisms that may make social norms more or less salient to influence adolescent early drinking. The current study looked to elucidate moderating factors that might impact the strength of association between social norms on adolescent early alcohol use. Specifically, agentic and communal social goals were tested as moderators of the association between descriptive and injunctive norms and alcohol use across early to middle adolescence. Findings supported the moderating role of social goals, but the effects depended on grade. Partial support was found for our hypothesis that descriptive norms would be a stronger predictor of alcohol use for adolescents with high levels of agentic goals. Perceptions of peer alcohol use (descriptive norms) were not prospectively associated with 7th grade alcohol use for adolescents with either low or high agentic goals. However, in later adolescence, descriptive norms came to be prospectively associated with 10th grade alcohol use for individuals characterized by high levels of agentic goals, suggesting that the moderating influence of agentic goals do not emerge until later adolescence. Several lines of evidence suggest that adolescence who value status and power (high agentic goals) may conform to peer drinking norms as a means to obtain or maintain social standing. Recent work suggests that alcohol use is linked to popular status, especially in later adolescence (Allen et al., 2005; Balsa et al., 2011). Moreover, there is evidence that popular peers are particularly susceptible to peer social norms because they are highly attuned to the behaviors of their peers and motivated to maintain their social status (Allen et al., 2005; Cillessen and Mayeux, 2004). These dynamics are likely not limited to alcohol use as evident by studies showing that popularity and high agency are associated with a wide variety of risk behavior (Mayeux et al., 2008; Markey et al., 2005). Contrary to our hypotheses, descriptive norms were prospectively associated with 7th grade alcohol use for adolescents with high leve.Ized by weak communal goals.Alcohol Clin Exp Res. Author manuscript; available in PMC 2016 December 01.Meisel and ColderPageInjunctive NormsAuthor Manuscript Author Manuscript Author Manuscript Author ManuscriptInjunctive Norms X Communal Goals As depicted in Panel C of Figure 1, 6th grade injunctive norms were associated with increased probability of alcohol in 7th grade alcohol use for adolescents with low (OR=2.91, p<.05), but not high (OR=0.76, p>.05) levels of communal goals. Moving to later adolescence, high levels of injunctive norms in 9th grade were associated with increased probability of alcohol use in 10th grade for adolescents with both low (OR=1.80, p>.05) and high (OR=2.68, p>.05) levels of communal goals. This pattern suggests that injunctive norms take on increasing importance in later adolescence across the spectrum of communal goals. These findings provide partial support for the hypothesized interaction between injunctive norms, high communal goals and grade but also contradict our hypotheses such that high levels of injunctive norms and low levels of communal goals predicted higher levels of alcohol use in later adolescence.DiscussionAlthough social norms are robust predictors of adolescent alcohol use (Borsari and Carey, 2001; Perkins, 2002), theoretical formulations suggest that the impact social norms have on behavior varies depending on their salience. Few studies have examined potential mechanisms that may make social norms more or less salient to influence adolescent early drinking. The current study looked to elucidate moderating factors that might impact the strength of association between social norms on adolescent early alcohol use. Specifically, agentic and communal social goals were tested as moderators of the association between descriptive and injunctive norms and alcohol use across early to middle adolescence. Findings supported the moderating role of social goals, but the effects depended on grade. Partial support was found for our hypothesis that descriptive norms would be a stronger predictor of alcohol use for adolescents with high levels of agentic goals. Perceptions of peer alcohol use (descriptive norms) were not prospectively associated with 7th grade alcohol use for adolescents with either low or high agentic goals. However, in later adolescence, descriptive norms came to be prospectively associated with 10th grade alcohol use for individuals characterized by high levels of agentic goals, suggesting that the moderating influence of agentic goals do not emerge until later adolescence. Several lines of evidence suggest that adolescence who value status and power (high agentic goals) may conform to peer drinking norms as a means to obtain or maintain social standing. Recent work suggests that alcohol use is linked to popular status, especially in later adolescence (Allen et al., 2005; Balsa et al., 2011). Moreover, there is evidence that popular peers are particularly susceptible to peer social norms because they are highly attuned to the behaviors of their peers and motivated to maintain their social status (Allen et al., 2005; Cillessen and Mayeux, 2004). These dynamics are likely not limited to alcohol use as evident by studies showing that popularity and high agency are associated with a wide variety of risk behavior (Mayeux et al., 2008; Markey et al., 2005). Contrary to our hypotheses, descriptive norms were prospectively associated with 7th grade alcohol use for adolescents with high leve.

S relating to commercial sex. In a safe environment, the dialogue

S relating to commercial sex. In a safe environment, the dialogue usually happened in such a natural and friendly sisterhood way, that it dispelled women’s fear of seeing a doctor for STIs, and made the sex topics easier to talk about. They would also chat about the new changes of the sex industry, through which information would be collected on where new FSW were appearing, whether there was drug use in the venue, which venue was cracked down, etc. We also observed that calls came in quite often to consult for health issues, especially about pregnancy and abortion, or asking for help to refer to other hospitals if the service is out of the range of this clinic. (Field notes, end of 1st week, buy Vasoactive Intestinal Peptide (human, rat, mouse, rabbit, canine, porcine) January 2012) These supportive clinical services, which incorporated respect, concern and relationship building, were essential parts of JZ’s success in working with FSW and surpass the services that would typically be provided to a patient (FSW or otherwise) in a standard clinical setting. Supportive services were especially important for attracting FSWs who were hard to reach through traditional outreach work, such as street-standing FSWs and women who were very mobile. For example, many migrant FSWs now come to the centre to get tested before returning to their hometowns for holidays. As noted by one FSW: I’ve known Dr Z for 4? years; she is a good and skilled person, we believe in her. ?I have a child and husband at home and I’ll visit them soon ?very exciting ?I usually go home once or twice a year and definitely don’t want to transmit to my family some disease, you know, in this business, it is hard to tell ?I don’t feel like I have a problem, but just to double check, to be safe and feel more comfortable. (FSW, in early 40s) A welcoming clinic setting and high-quality clinical services were both essential elements of JZ’s success; neither component alone would be as successful at attracting and maintaining FSW’s engagement with the programme services. Responsive outreach work with FSW–Outreach work consisted of on-site training to FSW about STI and HIV knowledge and strategies of how to avoid violence from clients and police, ML240 site distribution of IEC materials, on-site health consultations and collection of blood for STI tests, visitation of incarcerated FSW and additional supportive activities. JZ’s regular outreach work happens at least three times a week. The outreach activities are conducted by pairs of workers (either one peer leader trained FSW and one CBO worker or two CBO workers if no peer leaders are available) and generally involve walking the neighbourhoods to visit sex work venues one by one. For remote areas, staff take a taxi or bus, or sometimes used their own cars. All staff and management participated in outreach work. This comprehensive participation familiarised staff with the local FSWs’ work situations ?including venue organisation types ?which in turn benefited their intervention work. Outreach services covered different types of sex work venues from streets to large karaoke bars. The sites and content of the outreach services vary depending on the occupational issues arising during the current time period, JZ’s relationship with the venues and the business situation of each site. As outreach coordinator Miss Chen described:Author Manuscript Author Manuscript Author Manuscript Author ManuscriptGlob Public Health. Author manuscript; available in PMC 2016 August 01.Huang et al.PageYou can’t expect people to warmly welcome yo.S relating to commercial sex. In a safe environment, the dialogue usually happened in such a natural and friendly sisterhood way, that it dispelled women’s fear of seeing a doctor for STIs, and made the sex topics easier to talk about. They would also chat about the new changes of the sex industry, through which information would be collected on where new FSW were appearing, whether there was drug use in the venue, which venue was cracked down, etc. We also observed that calls came in quite often to consult for health issues, especially about pregnancy and abortion, or asking for help to refer to other hospitals if the service is out of the range of this clinic. (Field notes, end of 1st week, January 2012) These supportive clinical services, which incorporated respect, concern and relationship building, were essential parts of JZ’s success in working with FSW and surpass the services that would typically be provided to a patient (FSW or otherwise) in a standard clinical setting. Supportive services were especially important for attracting FSWs who were hard to reach through traditional outreach work, such as street-standing FSWs and women who were very mobile. For example, many migrant FSWs now come to the centre to get tested before returning to their hometowns for holidays. As noted by one FSW: I’ve known Dr Z for 4? years; she is a good and skilled person, we believe in her. ?I have a child and husband at home and I’ll visit them soon ?very exciting ?I usually go home once or twice a year and definitely don’t want to transmit to my family some disease, you know, in this business, it is hard to tell ?I don’t feel like I have a problem, but just to double check, to be safe and feel more comfortable. (FSW, in early 40s) A welcoming clinic setting and high-quality clinical services were both essential elements of JZ’s success; neither component alone would be as successful at attracting and maintaining FSW’s engagement with the programme services. Responsive outreach work with FSW–Outreach work consisted of on-site training to FSW about STI and HIV knowledge and strategies of how to avoid violence from clients and police, distribution of IEC materials, on-site health consultations and collection of blood for STI tests, visitation of incarcerated FSW and additional supportive activities. JZ’s regular outreach work happens at least three times a week. The outreach activities are conducted by pairs of workers (either one peer leader trained FSW and one CBO worker or two CBO workers if no peer leaders are available) and generally involve walking the neighbourhoods to visit sex work venues one by one. For remote areas, staff take a taxi or bus, or sometimes used their own cars. All staff and management participated in outreach work. This comprehensive participation familiarised staff with the local FSWs’ work situations ?including venue organisation types ?which in turn benefited their intervention work. Outreach services covered different types of sex work venues from streets to large karaoke bars. The sites and content of the outreach services vary depending on the occupational issues arising during the current time period, JZ’s relationship with the venues and the business situation of each site. As outreach coordinator Miss Chen described:Author Manuscript Author Manuscript Author Manuscript Author ManuscriptGlob Public Health. Author manuscript; available in PMC 2016 August 01.Huang et al.PageYou can’t expect people to warmly welcome yo.

Between the salaries of medical doctors and the TCs. . .[surgical assistants

Between the salaries of medical doctors and the TCs. . .[surgical assistants]. (Medical Doctor, Mozambique, Study # 4)Contrasting the findings associated with lower and higher levels of task shifting, it appears that structured career planning is more of an issue for skilled staff taking on new tasks. With that said, lower-level staff involved in task shifting, especially new lower cadres such as that envisioned in the Kenyan scheme, seem likely to view their training as an opportunity to become recognised providers of medical care. To prevent lower cadres being tempted to enact informal charging or to misrepresent themselves as nurses or doctors, lower cadres should be closely monitored and adequately paid. In addition, although this is less of a concern for lowerlevel workers, their formal position within the hierarchy of buy Pamapimod healthcare positions should be planned, and the requirements for entry to more advanced posts made clear.DiscussionLimitations and strengthsDefining task shifting in literature search Task-shifting interventions may not be labelled as such in literature. For example, systematic review of midwifery services found that although the term `task shifting’ was used commonly in relation to community health workers, `task shifting’ was used infrequently when describing interventions involving midwives (Colvin et al. 2013). Our literature search included terms that were synonymous/near synonymous with task shifting as well as a review of secondary references. The list of search terms was not exhaustive and it is possible that the studies identified were more likely to represent some cadres than others. Obtaining rich qualitative data As mentioned in the discussion on the quality of studies included in the review, qualitative studies published in health journals order GS-5816 provide a diverse, but somewhat limited amount of data. Further grey literature searches with focus on obtaining unpublished documents from various health organisations and identifying extensive ethnographic projects conducted by anthropologists would potentially provide richer data and inform subsequent analysis. Quality of the studies in the review Studies were included regardless of the quality score assigned. All studies provided narratives that were helpful in drawing a larger picture about the impact of task-shifting programmesAt the same time lower skilled cadres were often seen as part of the solution to providing healthcare to underserviced areas. They had good retention rates compared to higher skilled staff and they came at a substantially lower cost. It was widely acknowledged that lower, less skilled cadres performing tasks at a lower cost was in fact what made task shifting a plausible mechanism for providing additional health services in the first place:Skills of lower cadre health workers and especially community health workers are hardly portable both nationally and internationally. Lower cadre health workers can also be easily and cheaply recruited from within areas where they live and where they are supposed to be working. It is thus easy to retain these workers as?2016 The Authors. Journal of Clinical Nursing Published by John Wiley Sons Ltd. Journal of Clinical Nursing, 25, 2083?ReviewReview: Task shifting in sub-Saharan Africaon health workers. Due to limited researcher reflexivity and scant information about study informants, reliability of individual study findings was at times difficult to ascertain. It is likely that important perspectives.Between the salaries of medical doctors and the TCs. . .[surgical assistants]. (Medical Doctor, Mozambique, Study # 4)Contrasting the findings associated with lower and higher levels of task shifting, it appears that structured career planning is more of an issue for skilled staff taking on new tasks. With that said, lower-level staff involved in task shifting, especially new lower cadres such as that envisioned in the Kenyan scheme, seem likely to view their training as an opportunity to become recognised providers of medical care. To prevent lower cadres being tempted to enact informal charging or to misrepresent themselves as nurses or doctors, lower cadres should be closely monitored and adequately paid. In addition, although this is less of a concern for lowerlevel workers, their formal position within the hierarchy of healthcare positions should be planned, and the requirements for entry to more advanced posts made clear.DiscussionLimitations and strengthsDefining task shifting in literature search Task-shifting interventions may not be labelled as such in literature. For example, systematic review of midwifery services found that although the term `task shifting’ was used commonly in relation to community health workers, `task shifting’ was used infrequently when describing interventions involving midwives (Colvin et al. 2013). Our literature search included terms that were synonymous/near synonymous with task shifting as well as a review of secondary references. The list of search terms was not exhaustive and it is possible that the studies identified were more likely to represent some cadres than others. Obtaining rich qualitative data As mentioned in the discussion on the quality of studies included in the review, qualitative studies published in health journals provide a diverse, but somewhat limited amount of data. Further grey literature searches with focus on obtaining unpublished documents from various health organisations and identifying extensive ethnographic projects conducted by anthropologists would potentially provide richer data and inform subsequent analysis. Quality of the studies in the review Studies were included regardless of the quality score assigned. All studies provided narratives that were helpful in drawing a larger picture about the impact of task-shifting programmesAt the same time lower skilled cadres were often seen as part of the solution to providing healthcare to underserviced areas. They had good retention rates compared to higher skilled staff and they came at a substantially lower cost. It was widely acknowledged that lower, less skilled cadres performing tasks at a lower cost was in fact what made task shifting a plausible mechanism for providing additional health services in the first place:Skills of lower cadre health workers and especially community health workers are hardly portable both nationally and internationally. Lower cadre health workers can also be easily and cheaply recruited from within areas where they live and where they are supposed to be working. It is thus easy to retain these workers as?2016 The Authors. Journal of Clinical Nursing Published by John Wiley Sons Ltd. Journal of Clinical Nursing, 25, 2083?ReviewReview: Task shifting in sub-Saharan Africaon health workers. Due to limited researcher reflexivity and scant information about study informants, reliability of individual study findings was at times difficult to ascertain. It is likely that important perspectives.

He free radical chemistry of ROOH containing systems can proceed either

He free radical chemistry of ROOH containing systems can proceed either by O or O homolysis. Here we only discuss the chemistry of the O bond; the interested reader is pointed to a review of the radiation and photochemistry of peroxides, which discusses a variety of O bond homolysis reactions.230 PCET Caspase-3 InhibitorMedChemExpress Z-DEVD-FMK reactions of organic peroxyl radicals have almost always been understood as HAT reactions, especially the chain propagating stepChem Rev. Author manuscript; available in PMC 2011 December 8.Warren et al.Pagein autoxidation.17 This makes sense because of the strong ROO bonds, while PT-ET or ET-PT pathways are disfavored by the low basicity of ROO?and the moderate ROO?- potentials (Table 10). The most commonly employed organic hydroperoxide is tert-butyl hydroperoxide. The gas phase thermochemistry of organic peroxides has been widely discussed. Simmie et al.231 recently gave Hf?tBuOO? = -24.69 kcal mol-1, which, together with Hf?H? = 52.103 kcal mol-1 232 and Hf?tBuOOH) = -56.14 kcal mol-1 233, gives BDEg(tBuOOH) = 83.6 kcal mol-1.234 The pKas of several alkyl hydroperoxides and peracids have long been known,235 and pKa values for several peroxybenzoic acid have been reported.236 However, until recently, the reduction potentials of the corresponding peroxyl radicals have remained elusive. Das and co-workers indirectly measured the ROO?- couple for several peroxyl compounds in water (Table 10).237 Their value for E?tBuOO-/? is in good agreement with an earlier estimate made using kinetic and pKa data.238 In contrast, very little data exists on the redox potentials of percarboxylate anions. Peracids have gas phase BDFEs that are a little higher, and they are more acidic than the corresponding alkyl peroxides, which indicate that the RC(O)OO?- potentials are probably more oxidizing ( 1 V).239 Jonsson’s estimate of E?(CH3C(O)OO?-) = 1.14 V240 is in agreement with this estimate. Jonsson has also estimated thermochemical data for a variety of other peroxides but these need to be used with caution as they were extracted from electron transfer kinetic data240 and some of these values do not agree with those determined via more direct methods (e.g., Jonsson gives E?(Cl3COO?-) = 1.17 V while and Das reports E?Cl3COO?-) = 1.44 V237). 5.5 Simple Cycloheximide solubility nitrogen Compounds: Dinitrogen to Ammonia, Amines, and Arylamines The previous sections all focused on reagents with reactive O bonds. With this section we shift to N bonds, and those below deal with S and C bonds. While the same principles apply, there are some important differences. N bonds are less acidic than comparable O bonds, and in general N-lone pairs are higher in energy so nitrogen compounds are more basic and more easily lose an electron to form the radical cation. Therefore, stepwise PCET reactions of amines typically involve aminium radical cations (R3N?), particularly for arylamines, while those of alcohols and phenols involve alkoxides and phenoxides. We start with the simple gas phase species from N2 to ammonia, then progress to alkyl and aryl amines, and finally to more complex aromatic heterocycles of biological interest. 5.5.1 Dinitrogen, Diazine, and Hydrazine–Dinitrogen (N2) is one of the most abundant compounds on earth, making it an almost unlimited feedstock for the production of reduced nitrogen species such as ammonia. The overall reduction of dinitrogen to ammonia by dihydrogen is thermodynamically favorable under standard conditions both in the gas phase and in aqueous s.He free radical chemistry of ROOH containing systems can proceed either by O or O homolysis. Here we only discuss the chemistry of the O bond; the interested reader is pointed to a review of the radiation and photochemistry of peroxides, which discusses a variety of O bond homolysis reactions.230 PCET reactions of organic peroxyl radicals have almost always been understood as HAT reactions, especially the chain propagating stepChem Rev. Author manuscript; available in PMC 2011 December 8.Warren et al.Pagein autoxidation.17 This makes sense because of the strong ROO bonds, while PT-ET or ET-PT pathways are disfavored by the low basicity of ROO?and the moderate ROO?- potentials (Table 10). The most commonly employed organic hydroperoxide is tert-butyl hydroperoxide. The gas phase thermochemistry of organic peroxides has been widely discussed. Simmie et al.231 recently gave Hf?tBuOO? = -24.69 kcal mol-1, which, together with Hf?H? = 52.103 kcal mol-1 232 and Hf?tBuOOH) = -56.14 kcal mol-1 233, gives BDEg(tBuOOH) = 83.6 kcal mol-1.234 The pKas of several alkyl hydroperoxides and peracids have long been known,235 and pKa values for several peroxybenzoic acid have been reported.236 However, until recently, the reduction potentials of the corresponding peroxyl radicals have remained elusive. Das and co-workers indirectly measured the ROO?- couple for several peroxyl compounds in water (Table 10).237 Their value for E?tBuOO-/? is in good agreement with an earlier estimate made using kinetic and pKa data.238 In contrast, very little data exists on the redox potentials of percarboxylate anions. Peracids have gas phase BDFEs that are a little higher, and they are more acidic than the corresponding alkyl peroxides, which indicate that the RC(O)OO?- potentials are probably more oxidizing ( 1 V).239 Jonsson’s estimate of E?(CH3C(O)OO?-) = 1.14 V240 is in agreement with this estimate. Jonsson has also estimated thermochemical data for a variety of other peroxides but these need to be used with caution as they were extracted from electron transfer kinetic data240 and some of these values do not agree with those determined via more direct methods (e.g., Jonsson gives E?(Cl3COO?-) = 1.17 V while and Das reports E?Cl3COO?-) = 1.44 V237). 5.5 Simple Nitrogen Compounds: Dinitrogen to Ammonia, Amines, and Arylamines The previous sections all focused on reagents with reactive O bonds. With this section we shift to N bonds, and those below deal with S and C bonds. While the same principles apply, there are some important differences. N bonds are less acidic than comparable O bonds, and in general N-lone pairs are higher in energy so nitrogen compounds are more basic and more easily lose an electron to form the radical cation. Therefore, stepwise PCET reactions of amines typically involve aminium radical cations (R3N?), particularly for arylamines, while those of alcohols and phenols involve alkoxides and phenoxides. We start with the simple gas phase species from N2 to ammonia, then progress to alkyl and aryl amines, and finally to more complex aromatic heterocycles of biological interest. 5.5.1 Dinitrogen, Diazine, and Hydrazine–Dinitrogen (N2) is one of the most abundant compounds on earth, making it an almost unlimited feedstock for the production of reduced nitrogen species such as ammonia. The overall reduction of dinitrogen to ammonia by dihydrogen is thermodynamically favorable under standard conditions both in the gas phase and in aqueous s.

Nction constituted by suggested learning activities and the requirements of the

Nction constituted by suggested learning activities and the requirements of the learning environment from the foundation and AR characteristics can amend the gap in the learning outcomes and medical learners’ personal paradigms. The learning SCR7 site outcome, which combines Miller’s pyramid and Bloom’s taxonomy, can clarify the objectives and expectations and avoid teaching pitched at the wrong level [29]. Furthermore, we used a global health challenge–antibiotic resistance–as an application example and chose one important aspect that is the general practitioners’ rational use of antibiotics, to which to apply the MARE framework. With this framework, the expected abilities of GPs’ rational use of antibiotics are described specifically and may easily be executed and evaluated. The abilities were compared with the GP personal paradigm to solidify GP practical learning objectives and to help design learning environments and activities. LLY-507 side effects Future work will focus on the implementation of the proposed framework by developing a mobile phone-based AR app for GP training and for conducting evaluations in China.ConclusionsDue to the traditional teaching focus on recalling facts, health care professionals face the challenge of transforming knowledge into practice in health care settings. AR could provide a means to resolve this challenge, but it lacked a theory-guided design. Most AR apps still use traditional learning activities–see one,Conflicts of InterestNone declared.
REFLECTIONS: NEUROLOGY AND THE HUMANITIES Section Editor Michael H. Brooke, MDReflections for FebruaryMatthew B. Jensen, MD Erika L. Janik, MAWHAT’S WRONG WITH EVERYBODY?Address correspondence and reprint requests to Dr. Matthew B. Jensen, Comprehensive Stroke Program, Department of Neurology, School of Medicine and Public Health, University of Wisconsin, 1685 Highland Ave., Room 7273, Madison, WI 53705-2281 [email protected] wife and I at the breakfast table Sunday paper between us, describing a disaster somewhere, she concludes with, “The people ate can six fizzle.” “What?” I ask, looking up from the funny pages. Puzzled, she looks at me. “Worm didn’t hake Monday.” I laugh at this strange joke from my oldest friend, but stop when her face grows concerned. I try to ask her what’s wrong, but she ignores my question, blabbering more gibberish with a straight face. I rise to call 911 but she beats me to it. The paramedics arrive and I tell them what happened, but they ignore me, shining a light in my eyes, instructing me to “fop hund rund sun.” No, you idiots, there’s something wrong with my wife! In the Emergency Room a parade of doctors, nurses, others, ignoring my questions, talking among themselves, gobbletygook, claptrap, nonsense. Is this a big joke? Have we been attacked by nerve gas and I’m the only one immune? Who can I call for this, the Pentagon? They give me something through the IV, my wife holds my hand crying. The doctor returns to my room, on his last visit he earnestly told me to “zip the wachet unto three foamy.” I ask him for the thousandth time what is going on, but this time he looks at me, smiles, and says, “Good, now tell me your name.”Supported by grant 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources (NCRR), NIH. 582 Copyright ?2011 by AAN Enterprises, Inc.
Two populations of neurons in the arcuate nucleus of the hypothalamus (ARH) play an essential role in the regulation of energy h.Nction constituted by suggested learning activities and the requirements of the learning environment from the foundation and AR characteristics can amend the gap in the learning outcomes and medical learners’ personal paradigms. The learning outcome, which combines Miller’s pyramid and Bloom’s taxonomy, can clarify the objectives and expectations and avoid teaching pitched at the wrong level [29]. Furthermore, we used a global health challenge–antibiotic resistance–as an application example and chose one important aspect that is the general practitioners’ rational use of antibiotics, to which to apply the MARE framework. With this framework, the expected abilities of GPs’ rational use of antibiotics are described specifically and may easily be executed and evaluated. The abilities were compared with the GP personal paradigm to solidify GP practical learning objectives and to help design learning environments and activities. Future work will focus on the implementation of the proposed framework by developing a mobile phone-based AR app for GP training and for conducting evaluations in China.ConclusionsDue to the traditional teaching focus on recalling facts, health care professionals face the challenge of transforming knowledge into practice in health care settings. AR could provide a means to resolve this challenge, but it lacked a theory-guided design. Most AR apps still use traditional learning activities–see one,Conflicts of InterestNone declared.
REFLECTIONS: NEUROLOGY AND THE HUMANITIES Section Editor Michael H. Brooke, MDReflections for FebruaryMatthew B. Jensen, MD Erika L. Janik, MAWHAT’S WRONG WITH EVERYBODY?Address correspondence and reprint requests to Dr. Matthew B. Jensen, Comprehensive Stroke Program, Department of Neurology, School of Medicine and Public Health, University of Wisconsin, 1685 Highland Ave., Room 7273, Madison, WI 53705-2281 [email protected] wife and I at the breakfast table Sunday paper between us, describing a disaster somewhere, she concludes with, “The people ate can six fizzle.” “What?” I ask, looking up from the funny pages. Puzzled, she looks at me. “Worm didn’t hake Monday.” I laugh at this strange joke from my oldest friend, but stop when her face grows concerned. I try to ask her what’s wrong, but she ignores my question, blabbering more gibberish with a straight face. I rise to call 911 but she beats me to it. The paramedics arrive and I tell them what happened, but they ignore me, shining a light in my eyes, instructing me to “fop hund rund sun.” No, you idiots, there’s something wrong with my wife! In the Emergency Room a parade of doctors, nurses, others, ignoring my questions, talking among themselves, gobbletygook, claptrap, nonsense. Is this a big joke? Have we been attacked by nerve gas and I’m the only one immune? Who can I call for this, the Pentagon? They give me something through the IV, my wife holds my hand crying. The doctor returns to my room, on his last visit he earnestly told me to “zip the wachet unto three foamy.” I ask him for the thousandth time what is going on, but this time he looks at me, smiles, and says, “Good, now tell me your name.”Supported by grant 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources (NCRR), NIH. 582 Copyright ?2011 by AAN Enterprises, Inc.
Two populations of neurons in the arcuate nucleus of the hypothalamus (ARH) play an essential role in the regulation of energy h.

Anization and complexity. For example, if a particular set of states

Anization and complexity. For example, if a particular set of states and their dependent structure correspond to a highly robust yet agile Avasimibe web collective motion, then one can use this information theoretic inspired metrics for engineering the agent-to-agent interactions rather than focusing on the highly expensive computation strategy for an agent based model to achieve a certain degree of emergence, self-organization and complexity. We clarify this further in discussion section of manuscript. This framework can also help to study the evolution of the motion of various animal groups in nature to better understand their means to achieve energy efficiency46. The remaining of this paper is organized as follows: In the first section of results, we present our framework to extract the possible states in the collective motion and the strategy to build the corresponding energy landscape for transitions between them. To demonstrate the benefits of our approach, we first apply this strategy to quantify the energy landscape of a self-organizing model of a simulated group of agents based on local interactions among its individuals. Next, we define the missing information for the group structure. In the second section, we apply the same framework to three natural groups of swimming bacteria, flying pigeons and ants and study their energy landscapes. We define emergence, self-organization, and quantify the complexity of a collective motion based on these newly introduced metrics. For the case of bacteria, we concluded that adding chemoattractant to the environment, decreases the number of possible states for the group motion and the free energy landscape is smoother compared to the case without chemoattractant. Finally, the discussion section concludes the paper and outlines some future research directions.ResultsEstimating the free energy landscape for a collective motion based on identified spatio-temporal structural states of the group. The agents move Stattic chemical information coherently within a collective group while interactingwith their immediate neighbors and determine their overall trajectory of motion with respect to other agents. Consequently, the group’s structure evolves among various spatio-temporal structural states. We can identify and extract these states of the group moving in three-dimensional space from the individuals’ trajectories using our algorithm explained as follow (see the free energy landscape section in the Methods for more details). First, we divide the trajectories of all the individuals into equal sub-intervals of a specific lenght. Next, we compute the multivariable probability distribution function of the location of all the individuals in every sub-interval (Fig. 1a). We use Kantorovich metric (see equation (5) in free energy landscape section in Methods) to cluster these subinterval time series based on their similarities and closeness in the probability distribution function (Fig. 1b). Each cluster contains subintervals with similar dynamical configuration and can be interpreted as a distinct state.Scientific RepoRts | 6:27602 | DOI: 10.1038/srepwww.nature.com/scientificreports/Figure 2. Various collective patterns of a simulated model of a group of agents moving in a three dimensional space. (a) Torus: Individuals rotate around a center point within an empty space (See the simulation section in the Methods for more details about the model). (b) Swarm: Individuals show attraction and repulsion behavior between themselves and there is no ori.Anization and complexity. For example, if a particular set of states and their dependent structure correspond to a highly robust yet agile collective motion, then one can use this information theoretic inspired metrics for engineering the agent-to-agent interactions rather than focusing on the highly expensive computation strategy for an agent based model to achieve a certain degree of emergence, self-organization and complexity. We clarify this further in discussion section of manuscript. This framework can also help to study the evolution of the motion of various animal groups in nature to better understand their means to achieve energy efficiency46. The remaining of this paper is organized as follows: In the first section of results, we present our framework to extract the possible states in the collective motion and the strategy to build the corresponding energy landscape for transitions between them. To demonstrate the benefits of our approach, we first apply this strategy to quantify the energy landscape of a self-organizing model of a simulated group of agents based on local interactions among its individuals. Next, we define the missing information for the group structure. In the second section, we apply the same framework to three natural groups of swimming bacteria, flying pigeons and ants and study their energy landscapes. We define emergence, self-organization, and quantify the complexity of a collective motion based on these newly introduced metrics. For the case of bacteria, we concluded that adding chemoattractant to the environment, decreases the number of possible states for the group motion and the free energy landscape is smoother compared to the case without chemoattractant. Finally, the discussion section concludes the paper and outlines some future research directions.ResultsEstimating the free energy landscape for a collective motion based on identified spatio-temporal structural states of the group. The agents move coherently within a collective group while interactingwith their immediate neighbors and determine their overall trajectory of motion with respect to other agents. Consequently, the group’s structure evolves among various spatio-temporal structural states. We can identify and extract these states of the group moving in three-dimensional space from the individuals’ trajectories using our algorithm explained as follow (see the free energy landscape section in the Methods for more details). First, we divide the trajectories of all the individuals into equal sub-intervals of a specific lenght. Next, we compute the multivariable probability distribution function of the location of all the individuals in every sub-interval (Fig. 1a). We use Kantorovich metric (see equation (5) in free energy landscape section in Methods) to cluster these subinterval time series based on their similarities and closeness in the probability distribution function (Fig. 1b). Each cluster contains subintervals with similar dynamical configuration and can be interpreted as a distinct state.Scientific RepoRts | 6:27602 | DOI: 10.1038/srepwww.nature.com/scientificreports/Figure 2. Various collective patterns of a simulated model of a group of agents moving in a three dimensional space. (a) Torus: Individuals rotate around a center point within an empty space (See the simulation section in the Methods for more details about the model). (b) Swarm: Individuals show attraction and repulsion behavior between themselves and there is no ori.

Ith grade. No systematic associations were observed between agentic goals and

Ith grade. No systematic associations were observed between agentic goals and alcohol use (6th grade: r=.02, 7th grade: r=.17, 8th grade: r=.04, 9th grade: r=.11) and the strength of the association between communal goals and alcohol use decreased with grade (6th grade: r=.22, 7th grade: r=.13, 8th grade: r=.04, 9th grade: r=.-.03).Alcohol Clin Exp Res. Author manuscript; available in PMC 2016 December 01.Meisel and ColderPageMultilevel ModelsAuthor get 3-MA Manuscript Author Manuscript Author Manuscript Author ManuscriptThe gender interaction terms did not significantly improve model fit (2 [8, N=386]=5.16, p>.05), and were not considered further. However, the first-order effect of gender was included as a statistical control variable in models testing grade interaction terms. A nested chi-square test comparing a model with and without the hypothesized interaction terms with grade suggested that model fit improved with the inclusion of twoway (2 [8, N=386]=18.25, p<.05) and three-way (2 [4, N=386]=11.21, p<.05) interactions. As shown in Table 1, significant three-way interaction terms were found for grade ?descriptive norm ?communal goals (B =-0.33, p=.03), grade ?injunctive norms ?communal goals (B =0.30, p=.03), and grade ?descriptive norms ?agentic goals (B=0.24, p=.04). The grade ?injunctive norms ?agentic goals three-way interaction term was not statistically significant (B =-0.15, p=.30). To facilitate interpretation of the three-way interaction terms, simple slopes of norms by levels of social goals were plotted for an early (6th variables predicting 7th grade alcohol use) and late (9th grade variables predicting 10 grade alcohol use) cross-lag (see Figure 1). Descriptive Norms Descriptive Norms and Agentic Goals As seen in Panel A of Figure 1, for adolescents in the 6th grade, descriptive norms were not found to significantly predict 7th grade alcohol use for adolescents with high or low levels of agentic goals (OR=0.86 and 1.71, respectively, both ps>.05). High levels of descriptive norms in the 9th grade were AZD4547 biological activity associated with increased probability of alcohol use in the 10th grade for adolescents with high (OR=2.43 p<.05), but not low (OR=1.09, p>.05) levels of agentic goals. This pattern provides partial support for the hypothesized interaction between descriptive norms, agentic goals and grade. That is, there was a shift in the moderating role of agentic social goals with grade, such that descriptive norms became a predictor of alcohol use for youth characterized by strong agentic goals, but only in later grades. Descriptive Norms and Communal Goals High levels of descriptive norms in the 6th grade were associated with increased probability of alcohol use in the 7th grade for adolescents characterized by high (OR=2.07, p<.05) but not low (OR=0.72, p>.05) levels of communal goals. As seen in Panel 2 of Figure 1, in later grades, this pattern reversed itself, such that 9th grade descriptive norms were not associated with 10th grade drinking for adolescents high in communal goals (OR=0.72, p>.05), but they were associated with 10th grade drinking for adolescents low in communal goals (OR=2.58, p>.05). Although descriptive norms were not hypothesized to interact with communal goals, these findings suggest a developmental shift such that in early adolescence, descriptive norms influence alcohol use for those characterized by strong communal goals whereas in later adolescence descriptive norms influence alcohol use for adolescents character.Ith grade. No systematic associations were observed between agentic goals and alcohol use (6th grade: r=.02, 7th grade: r=.17, 8th grade: r=.04, 9th grade: r=.11) and the strength of the association between communal goals and alcohol use decreased with grade (6th grade: r=.22, 7th grade: r=.13, 8th grade: r=.04, 9th grade: r=.-.03).Alcohol Clin Exp Res. Author manuscript; available in PMC 2016 December 01.Meisel and ColderPageMultilevel ModelsAuthor Manuscript Author Manuscript Author Manuscript Author ManuscriptThe gender interaction terms did not significantly improve model fit (2 [8, N=386]=5.16, p>.05), and were not considered further. However, the first-order effect of gender was included as a statistical control variable in models testing grade interaction terms. A nested chi-square test comparing a model with and without the hypothesized interaction terms with grade suggested that model fit improved with the inclusion of twoway (2 [8, N=386]=18.25, p<.05) and three-way (2 [4, N=386]=11.21, p<.05) interactions. As shown in Table 1, significant three-way interaction terms were found for grade ?descriptive norm ?communal goals (B =-0.33, p=.03), grade ?injunctive norms ?communal goals (B =0.30, p=.03), and grade ?descriptive norms ?agentic goals (B=0.24, p=.04). The grade ?injunctive norms ?agentic goals three-way interaction term was not statistically significant (B =-0.15, p=.30). To facilitate interpretation of the three-way interaction terms, simple slopes of norms by levels of social goals were plotted for an early (6th variables predicting 7th grade alcohol use) and late (9th grade variables predicting 10 grade alcohol use) cross-lag (see Figure 1). Descriptive Norms Descriptive Norms and Agentic Goals As seen in Panel A of Figure 1, for adolescents in the 6th grade, descriptive norms were not found to significantly predict 7th grade alcohol use for adolescents with high or low levels of agentic goals (OR=0.86 and 1.71, respectively, both ps>.05). High levels of descriptive norms in the 9th grade were associated with increased probability of alcohol use in the 10th grade for adolescents with high (OR=2.43 p<.05), but not low (OR=1.09, p>.05) levels of agentic goals. This pattern provides partial support for the hypothesized interaction between descriptive norms, agentic goals and grade. That is, there was a shift in the moderating role of agentic social goals with grade, such that descriptive norms became a predictor of alcohol use for youth characterized by strong agentic goals, but only in later grades. Descriptive Norms and Communal Goals High levels of descriptive norms in the 6th grade were associated with increased probability of alcohol use in the 7th grade for adolescents characterized by high (OR=2.07, p<.05) but not low (OR=0.72, p>.05) levels of communal goals. As seen in Panel 2 of Figure 1, in later grades, this pattern reversed itself, such that 9th grade descriptive norms were not associated with 10th grade drinking for adolescents high in communal goals (OR=0.72, p>.05), but they were associated with 10th grade drinking for adolescents low in communal goals (OR=2.58, p>.05). Although descriptive norms were not hypothesized to interact with communal goals, these findings suggest a developmental shift such that in early adolescence, descriptive norms influence alcohol use for those characterized by strong communal goals whereas in later adolescence descriptive norms influence alcohol use for adolescents character.

S relating to commercial sex. In a safe environment, the dialogue

S relating to commercial sex. In a safe environment, the dialogue usually happened in such a natural and friendly sisterhood way, that it dispelled women’s fear of seeing a doctor for STIs, and made the sex topics easier to talk about. They would also chat about the new changes of the sex industry, through which information would be collected on where new FSW were appearing, whether there was drug use in the venue, which venue was cracked down, etc. We also observed that calls came in quite often to consult for health issues, especially about pregnancy and abortion, or asking for help to refer to other hospitals if the service is out of the range of this clinic. (Field notes, end of 1st week, January 2012) These supportive clinical services, which incorporated respect, concern and relationship building, were essential parts of JZ’s success in working with FSW and surpass the C.I. 75535MedChemExpress Isoarnebin 4 services that would typically be provided to a patient (FSW or otherwise) in a standard clinical setting. Supportive services were especially important for attracting FSWs who were hard to reach through traditional outreach work, such as street-standing FSWs and women who were very mobile. For example, many migrant FSWs now come to the centre to get tested before returning to their hometowns for holidays. As noted by one FSW: I’ve known Dr Z for 4? years; she is a good and skilled person, we believe in her. ?I have a child and husband at home and I’ll visit them soon ?very exciting ?I usually go home once or twice a year and definitely don’t want to transmit to my family some disease, you know, in this business, it is hard to tell ?I don’t feel like I have a problem, but just to double check, to be safe and feel more comfortable. (FSW, in early 40s) A welcoming clinic setting and high-quality clinical services were both essential elements of JZ’s success; neither component alone would be as successful at attracting and maintaining FSW’s engagement with the programme services. Responsive outreach work with FSW–Outreach work consisted of on-site training to FSW about STI and HIV knowledge and strategies of how to avoid violence from clients and police, distribution of IEC materials, on-site health consultations and collection of blood for STI tests, visitation of incarcerated FSW and additional supportive activities. JZ’s regular outreach work happens at least three times a week. The outreach activities are conducted by pairs of workers (either one peer leader trained FSW and one CBO worker or two CBO workers if no peer leaders are available) and generally involve walking the neighbourhoods to visit sex work venues one by one. For remote areas, staff take a taxi or bus, or sometimes used their own cars. All staff and management participated in outreach work. This comprehensive participation familiarised staff with the local FSWs’ work situations ?including venue organisation types ?which in turn benefited their intervention work. Outreach services covered different types of sex work venues from streets to large karaoke bars. The sites and content of the outreach services vary depending on the occupational issues arising during the current time period, JZ’s relationship with the venues and the business Ornipressin web situation of each site. As outreach coordinator Miss Chen described:Author Manuscript Author Manuscript Author Manuscript Author ManuscriptGlob Public Health. Author manuscript; available in PMC 2016 August 01.Huang et al.PageYou can’t expect people to warmly welcome yo.S relating to commercial sex. In a safe environment, the dialogue usually happened in such a natural and friendly sisterhood way, that it dispelled women’s fear of seeing a doctor for STIs, and made the sex topics easier to talk about. They would also chat about the new changes of the sex industry, through which information would be collected on where new FSW were appearing, whether there was drug use in the venue, which venue was cracked down, etc. We also observed that calls came in quite often to consult for health issues, especially about pregnancy and abortion, or asking for help to refer to other hospitals if the service is out of the range of this clinic. (Field notes, end of 1st week, January 2012) These supportive clinical services, which incorporated respect, concern and relationship building, were essential parts of JZ’s success in working with FSW and surpass the services that would typically be provided to a patient (FSW or otherwise) in a standard clinical setting. Supportive services were especially important for attracting FSWs who were hard to reach through traditional outreach work, such as street-standing FSWs and women who were very mobile. For example, many migrant FSWs now come to the centre to get tested before returning to their hometowns for holidays. As noted by one FSW: I’ve known Dr Z for 4? years; she is a good and skilled person, we believe in her. ?I have a child and husband at home and I’ll visit them soon ?very exciting ?I usually go home once or twice a year and definitely don’t want to transmit to my family some disease, you know, in this business, it is hard to tell ?I don’t feel like I have a problem, but just to double check, to be safe and feel more comfortable. (FSW, in early 40s) A welcoming clinic setting and high-quality clinical services were both essential elements of JZ’s success; neither component alone would be as successful at attracting and maintaining FSW’s engagement with the programme services. Responsive outreach work with FSW–Outreach work consisted of on-site training to FSW about STI and HIV knowledge and strategies of how to avoid violence from clients and police, distribution of IEC materials, on-site health consultations and collection of blood for STI tests, visitation of incarcerated FSW and additional supportive activities. JZ’s regular outreach work happens at least three times a week. The outreach activities are conducted by pairs of workers (either one peer leader trained FSW and one CBO worker or two CBO workers if no peer leaders are available) and generally involve walking the neighbourhoods to visit sex work venues one by one. For remote areas, staff take a taxi or bus, or sometimes used their own cars. All staff and management participated in outreach work. This comprehensive participation familiarised staff with the local FSWs’ work situations ?including venue organisation types ?which in turn benefited their intervention work. Outreach services covered different types of sex work venues from streets to large karaoke bars. The sites and content of the outreach services vary depending on the occupational issues arising during the current time period, JZ’s relationship with the venues and the business situation of each site. As outreach coordinator Miss Chen described:Author Manuscript Author Manuscript Author Manuscript Author ManuscriptGlob Public Health. Author manuscript; available in PMC 2016 August 01.Huang et al.PageYou can’t expect people to warmly welcome yo.

Between the salaries of medical doctors and the TCs. . .[surgical assistants

Between the salaries of medical doctors and the TCs. . .[surgical assistants]. (Medical Doctor, Mozambique, Study # 4)Contrasting the findings associated with lower and higher levels of task shifting, it appears that structured career planning is more of an issue for skilled staff taking on new tasks. With that said, lower-level staff involved in task shifting, R1503 chemical information especially new lower cadres such as that envisioned in the Kenyan scheme, seem likely to view their training as an opportunity to become recognised providers of medical care. To prevent lower cadres being tempted to enact informal charging or to misrepresent themselves as nurses or doctors, lower cadres should be closely monitored and adequately paid. In addition, although this is less of a concern for lowerlevel workers, their formal position within the hierarchy of healthcare positions should be planned, and the requirements for entry to more advanced posts made clear.DiscussionLimitations and strengthsDefining task shifting in literature search Task-shifting interventions may not be labelled as such in literature. For example, systematic review of midwifery services found that although the term `task shifting’ was used commonly in relation to community health workers, `task shifting’ was used infrequently when describing interventions involving midwives (Colvin et al. 2013). Our literature search included terms that were synonymous/near synonymous with task shifting as well as a review of secondary references. The list of search terms was not exhaustive and it is possible that the Leupeptin (hemisulfate) web studies identified were more likely to represent some cadres than others. Obtaining rich qualitative data As mentioned in the discussion on the quality of studies included in the review, qualitative studies published in health journals provide a diverse, but somewhat limited amount of data. Further grey literature searches with focus on obtaining unpublished documents from various health organisations and identifying extensive ethnographic projects conducted by anthropologists would potentially provide richer data and inform subsequent analysis. Quality of the studies in the review Studies were included regardless of the quality score assigned. All studies provided narratives that were helpful in drawing a larger picture about the impact of task-shifting programmesAt the same time lower skilled cadres were often seen as part of the solution to providing healthcare to underserviced areas. They had good retention rates compared to higher skilled staff and they came at a substantially lower cost. It was widely acknowledged that lower, less skilled cadres performing tasks at a lower cost was in fact what made task shifting a plausible mechanism for providing additional health services in the first place:Skills of lower cadre health workers and especially community health workers are hardly portable both nationally and internationally. Lower cadre health workers can also be easily and cheaply recruited from within areas where they live and where they are supposed to be working. It is thus easy to retain these workers as?2016 The Authors. Journal of Clinical Nursing Published by John Wiley Sons Ltd. Journal of Clinical Nursing, 25, 2083?ReviewReview: Task shifting in sub-Saharan Africaon health workers. Due to limited researcher reflexivity and scant information about study informants, reliability of individual study findings was at times difficult to ascertain. It is likely that important perspectives.Between the salaries of medical doctors and the TCs. . .[surgical assistants]. (Medical Doctor, Mozambique, Study # 4)Contrasting the findings associated with lower and higher levels of task shifting, it appears that structured career planning is more of an issue for skilled staff taking on new tasks. With that said, lower-level staff involved in task shifting, especially new lower cadres such as that envisioned in the Kenyan scheme, seem likely to view their training as an opportunity to become recognised providers of medical care. To prevent lower cadres being tempted to enact informal charging or to misrepresent themselves as nurses or doctors, lower cadres should be closely monitored and adequately paid. In addition, although this is less of a concern for lowerlevel workers, their formal position within the hierarchy of healthcare positions should be planned, and the requirements for entry to more advanced posts made clear.DiscussionLimitations and strengthsDefining task shifting in literature search Task-shifting interventions may not be labelled as such in literature. For example, systematic review of midwifery services found that although the term `task shifting’ was used commonly in relation to community health workers, `task shifting’ was used infrequently when describing interventions involving midwives (Colvin et al. 2013). Our literature search included terms that were synonymous/near synonymous with task shifting as well as a review of secondary references. The list of search terms was not exhaustive and it is possible that the studies identified were more likely to represent some cadres than others. Obtaining rich qualitative data As mentioned in the discussion on the quality of studies included in the review, qualitative studies published in health journals provide a diverse, but somewhat limited amount of data. Further grey literature searches with focus on obtaining unpublished documents from various health organisations and identifying extensive ethnographic projects conducted by anthropologists would potentially provide richer data and inform subsequent analysis. Quality of the studies in the review Studies were included regardless of the quality score assigned. All studies provided narratives that were helpful in drawing a larger picture about the impact of task-shifting programmesAt the same time lower skilled cadres were often seen as part of the solution to providing healthcare to underserviced areas. They had good retention rates compared to higher skilled staff and they came at a substantially lower cost. It was widely acknowledged that lower, less skilled cadres performing tasks at a lower cost was in fact what made task shifting a plausible mechanism for providing additional health services in the first place:Skills of lower cadre health workers and especially community health workers are hardly portable both nationally and internationally. Lower cadre health workers can also be easily and cheaply recruited from within areas where they live and where they are supposed to be working. It is thus easy to retain these workers as?2016 The Authors. Journal of Clinical Nursing Published by John Wiley Sons Ltd. Journal of Clinical Nursing, 25, 2083?ReviewReview: Task shifting in sub-Saharan Africaon health workers. Due to limited researcher reflexivity and scant information about study informants, reliability of individual study findings was at times difficult to ascertain. It is likely that important perspectives.

Rey) with vestiges of sauropod tracks; south of James Price Point.

Rey) with vestiges of sauropod tracks; south of James Price Point. B, a similar but smaller feature at James Price Point, at the very margin of the lower-lying areas shown in Figure 24. The two water-filled areas at left and right have been trodden down by sauropods to leave an `anticlinal’ fold between them. doi:10.1371/journal.pone.0036208.gtransmitted reliefs of an entire trackway. In theory the same concession might extend ultimately to regions of deformed bedding that resemble minor tectonic structures and even to the larger features of physical geography seen at James Price Point. In effect, the state of ichnotaxonomy would come to resemble that of CibinetideMedChemExpress Cibinetide zoological taxonomy when the available names of taxa were extended to the `work’ of animals [47]. Seemingly valid ichnotaxonomic names might be bestowed on geographic features of the Dampier coast, in just the way that the name Homo sapiens might be applied to all and any human artefacts, from stone axes to space shuttles. It seems preferable to avoid that incongruous outcome by maintaining the genuine, if arbitrary, distinction between footprints and sedimentary structures (patterns of deformation) which are associated with footprints. That policy is, in fact, consistent with conventional practice in ichnotaxonomy, where features of transmitted relief are disregarded or treated, at best, as an indirect and inferior source of information about the `true’ footprints. Footprints, sensu stricto, are definitely objects of organic origin whereas the development of transmitted reliefs depends as much on the nature of the substrate as it does on the intervention of a track-maker. In fact, the development of transmitted relief, in the broadest sense, does not necessarily require the active involvement of a track-maker. In theory transmitted reliefs might be produced by organisms which are inert (e.g. a carcass settlingon to the floor of a lagoon) or by the impact of inorganic objects such as drop-stones, lapilli, volcanic bombs, meteorites or hail. Even so, the taxonomic implications should not be overrated. Ideally ichnotaxa should be established on type material comprising one or more footprints (true tracks), not transmitted reliefs (undertracks). But that is merely the description of ideal practice; it is not the stipulation of a mandatory requirement. Each case is to be judged on its individual XR9576 site merits, and no great harm will ensue if a valid ichnospecies should transpire to be founded on transmitted relief rather than a footprint (a true track). In practice all that matters is that type material should be adequate and diagnostic, regardless of its status as footprint or transmitted relief. That concession is not the thin end of a wedge that would ultimately permit all and any transmitted reliefs to be classified as conventional ichnotaxa, because only the most proximal reliefs are likely to retain the morphological details required to discriminate a valid ichnospecies. The more distal transmitted reliefs lack such consistent morphological detail and are far less likely to be mistaken for footprints (true tracks) – though they might easily and more appropriately be classified as a series of sedimentary structures (e.g. bowls, basins, troughs and folds of various shapes and sizes).Previous interpretationsSome of the sedimentary features described here may have attracted attention in the past, though the sauropod tracks werePLoS ONE | www.plosone.orgSubstrates Deformed by Cretaceous Dinosaurs.Rey) with vestiges of sauropod tracks; south of James Price Point. B, a similar but smaller feature at James Price Point, at the very margin of the lower-lying areas shown in Figure 24. The two water-filled areas at left and right have been trodden down by sauropods to leave an `anticlinal’ fold between them. doi:10.1371/journal.pone.0036208.gtransmitted reliefs of an entire trackway. In theory the same concession might extend ultimately to regions of deformed bedding that resemble minor tectonic structures and even to the larger features of physical geography seen at James Price Point. In effect, the state of ichnotaxonomy would come to resemble that of zoological taxonomy when the available names of taxa were extended to the `work’ of animals [47]. Seemingly valid ichnotaxonomic names might be bestowed on geographic features of the Dampier coast, in just the way that the name Homo sapiens might be applied to all and any human artefacts, from stone axes to space shuttles. It seems preferable to avoid that incongruous outcome by maintaining the genuine, if arbitrary, distinction between footprints and sedimentary structures (patterns of deformation) which are associated with footprints. That policy is, in fact, consistent with conventional practice in ichnotaxonomy, where features of transmitted relief are disregarded or treated, at best, as an indirect and inferior source of information about the `true’ footprints. Footprints, sensu stricto, are definitely objects of organic origin whereas the development of transmitted reliefs depends as much on the nature of the substrate as it does on the intervention of a track-maker. In fact, the development of transmitted relief, in the broadest sense, does not necessarily require the active involvement of a track-maker. In theory transmitted reliefs might be produced by organisms which are inert (e.g. a carcass settlingon to the floor of a lagoon) or by the impact of inorganic objects such as drop-stones, lapilli, volcanic bombs, meteorites or hail. Even so, the taxonomic implications should not be overrated. Ideally ichnotaxa should be established on type material comprising one or more footprints (true tracks), not transmitted reliefs (undertracks). But that is merely the description of ideal practice; it is not the stipulation of a mandatory requirement. Each case is to be judged on its individual merits, and no great harm will ensue if a valid ichnospecies should transpire to be founded on transmitted relief rather than a footprint (a true track). In practice all that matters is that type material should be adequate and diagnostic, regardless of its status as footprint or transmitted relief. That concession is not the thin end of a wedge that would ultimately permit all and any transmitted reliefs to be classified as conventional ichnotaxa, because only the most proximal reliefs are likely to retain the morphological details required to discriminate a valid ichnospecies. The more distal transmitted reliefs lack such consistent morphological detail and are far less likely to be mistaken for footprints (true tracks) – though they might easily and more appropriately be classified as a series of sedimentary structures (e.g. bowls, basins, troughs and folds of various shapes and sizes).Previous interpretationsSome of the sedimentary features described here may have attracted attention in the past, though the sauropod tracks werePLoS ONE | www.plosone.orgSubstrates Deformed by Cretaceous Dinosaurs.