Local Resources Research Articles

Connecting unstably housed veterans living in rural areas to health care: Perspectives from Health Care Navigators.

To understand existing care practices and policies, and potential enhancements, to improve the effectiveness of the US Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) Health Care Navigators (HCN) in linking Veterans experiencing housing instability in rural areas with health care services. We used primary data collected during semistructured interviews with HCNs (n = 21) serving rural areas across the United States during Spring 2022. We applied the Consolidated Framework for Implementation Research (CFIR) 2009 and the Social Ecological Model (SEM) to the collection and analysis of qualitative data to understand how HCNs administer services within SSVF and the larger community. We used rapid qualitative methods to summarize and analyze data. Templated matrix summaries identified facilitators and barriers to linking Veterans with health care services and policy and practice implications. Using CFIR 2009, we identified contextual factors affecting successful implementation of HCN services within SSVF; we offer a crosswalk between CFIR 2009 and the version updated in 2022. Framing facilitators and barriers within the SEM provided insight into whether implementation strategies should be addressed at a community, interpersonal, or intrapersonal level within the SEM. Facilitators included sufficient knowledge, training, and mentorship opportunities for HCNs and their capacity to collaborate within their organization and with other community-based organizations. Barriers included lack of local technology and housing resources, inadequate understanding of Veterans' service eligibilities and pathways to access those services, and deficient collaboration with the VA. Understanding facilitators and barriers experienced by HCN when linking unstably housed Veterans in rural areas with health care services can inform future strategies, including policy changes such as increased training to support HCNs' understanding of eligibility, benefits, and entitlements as well as improving communication and collaboration between VA and community partners.

Genetic Profile of Greek Indigenous Honey Bee Populations, Local Extinctions, Geographical Distinction, and Patterns, by Using mtDNA COI and Nuclear CSD Gene Analysis Markers

Evaluation and conservation of local genetic resources of the domestic honey bee populations is important, especially in regions with high diversity levels as well as high honey bee colony density. Greece is rich in honey bee biodiversity, hosting several subspecies, with the status of them being, though, doubtful. The purpose of the present study was to investigate the genetic relationships of both stationary and movable honey bee populations, originating from many location throughout Greece. Two molecular markers were utilized, namely, the conserved mitochondrial COI gene and the highly variable complementary sex determination (CSD) gene. Samples were collected from nine distant populations: eight populations from colonies that followed the traditional stationary beekeeping model and one following the modern migratory beekeeping model type, where the hives are transferred from place to place according to the season. Regardless the beekeeping model, all populations were characterized by sufficient genetic diversity indicating no signs of inbreeding or any bottleneck effects. Nevertheless, genetic differentiation and phylogenetic analysis in comparison with haplotypes obtained from GenBank revealed a genetic admixture pattern suggesting that movement causes genetic homogeneity, occasionally in the stable reared populations as well. Interestingly, two populations, namely, Kastoria and Protokklisi, belonging to A. m. macedonica population, were significantly differentiated, supporting the maintenance of their genetic integrity. Unfortunately, on the other hand, genetic structure of the populations from Crete (Sasalos population) provided evidence that the indigenous breed from the island, A. m. adami, has probably gone extinct. Future management strategies should focus on the conservation of the local genetic resources in which distinct genetic identity has been sustained.

Bryofloristic diversity and conservation value of a protected area in the Brazilian semi-arid region

We collected 137 samples (71—rainy season; 66—dry) for the Brazilian state of Paraíba. With a total of 23 species (one hornwort, 14 mosses and nine liverworts), we updated the bryoflora of Paraíba, a hotspot of bryophytes, by one rare species (Weissia controversa), increasing the total number of species to 188. The floristic composition in the Poeta e Repentista Juvenal de Oliveira State Park is affected by chronic anthropogenic disturbances, and is typical of arid environments, regardless of the season. This indicates homogenization of the habitat from the loss of ecological niche due to the disordered use of local natural resources. However, the record of Philonotis hastata, categorized as Near Threatened by the IUCN; the geographic expansion of a species; and the presence of rare species for Brazil reinforce the importance of the Conservation Unit for bryophyte biodiversity. Despite the floristic composition, we identified that interpretations about biology, environmental functionality and species distribution are more consistent for environmental assessment and decision-making on conservation actions.

Electronic distance based clinical skills training development in family medicine in Namibia

Workplace-based evaluation is one of the most important, but challenging aspects of medical education. The aim was to improve the assessment of the rural community-based clinical training for undergraduate 3rd and 4th year family medicine students at the University of Namibia (UNAM) and implement a paperless process. An online module was developed on the Moodle platform to include a study guide, an electronic portfolio, and electronic resources (e-books and apps) to replace the current paper version of the logbook. We explored local resources by engaging with students and clinical trainers on how to best conduct the initial implementation. Engagement also entailed motivating students to actively participate in the implementation process. All 3rd and 4th year community-based education end service (COBES) students are now submitting proof of clinical learning electronically with the use of their phones in their online portfolio and using online resources. In addition, students in the practical family medicine module that has been introduced in the 6th year since 2023 are now also using an electronic portfolio and these assessment tools.Contribution: Overall feedback from students and supervisors indicates a positive atmosphere of learning and constructive feedback on performance from all team members, hopefully improving work-based assessments and ultimately patient care. More members of the primary health care team were involved and the carbon footprint has also been decreased.

Effect of The Ratio of Purple Sweet Potato Flour and Rice Crust Flour on The Physical, Chemical, and Sensory Properties of High-Fiber Snack Bar

Dietary fiber, an indigestible component of plants, offers significant health benefits for humans. Creating a high-fiber snack bar can be a substitute for meeting daily requirements for dietary fiber. This research aimed to create snack bar products utilizing locally sourced ingredients, specifically rice crust flour and purple sweet potato flour, with the goal of optimizing the utilization of local food resources and enhancing the diversity of Indonesian cuisine. This study aimed to investigate how the proportion of purple sweet potato flour and rice crust flour influenced the chemical, physical, and sensory characteristics of the high-fiber snack bars that were created. The proportions of purple sweet potato flour to rice crust flour differed across the four snack bar formulas: FI (100%:0%), F2 (90%:10%), F3 (80%:20%), and F4 (70%:30%). The effectiveness index method was employed to determine the optimal formulation for the snack bar. The results indicated that lowering the proportion of purple sweet potato flour would enhance the firmness and color of the snack bar. The dietary fiber content (%db) of each formula was as follows: F1 (18.92 ± 1.43%), F2 (18.33 ± 0.79%), F3 (18.56 ± 2.73%), and F4 (19.48 ± 0.40%). The sensory test results showed a direct correlation between the panelists' preference level and the decrease in the proportion of purple sweet potato flour. Formula F4, consisting of a 70% proportion of purple sweet potato flour and a 30% proportion of rice crust flour, is the optimal formula for creating a snack bar.

Differential consumption pattern of traditional and packed food among rural children

The food consumption pattern of an individual reflects their food choices rather than nutrient intake in their diet. These patterns are strongly related to the health outcomes of the individuals. Home-cooked traditional food items are rapidly replaced by packed food items. As children being the future of any nation, thus their health is very important Therefore, improving the nutrition of these children would help to reduce health risks by promoting healthy food consumption. Present study was carried out during 2021–23 to understand the differential consumption pattern of traditional and packed food items among children in rural areas of Madhya Pradesh and Chhattisgarh. The data pertaining to study were collected using food frequency questionnaire with 2–5 years and 6–14 years old children. The key results indicated that packed food item consumption was dominant among 2–5-year-old children in their diets in NSV (Nutri-SMART villages), and non-NSV as explained maximum variation. However, among 6–14 years old children traditional and packed food items consumption was dominant in NSV, while packed food items were dominant in non-NSV as explained by maximum variation. There is a need to design local food resources based strategies to make aware the children about healthy food items and encourage them to consume by targeting access and availability of such foods.

Technical and economic study of renewable-energy-powered system for a newly constructed city in China

The power and transportation sectors are major carbon emission sources of cities in China, meanwhile, urbanization and industrialization remain the most important impetus for the Chinese economy. Thus, urban-level carbon mitigation is critical for China to realize a low carbon development strategy. This study designs two renewable-energy power-generation dominated power systems for a totally newly built Chinese city, Xiongan, considering emerging technologies, such as vehicle-to-grid as an energy storage facility and geothermal as a local renewable energy resource. The new energy systems are assessed from both economic and carbon emission aspects based on short &long terms power load forecasts. The simulation results shows that the optimal short-term system is a photovoltaic (PV)/geothermal generator/grid purchase/100 Li battery/converter. For the short term, the system's net present cost (NPC) is approximately $8.26B, and the average cost of valuable electrical energy (COE) produced by the system is approximately $0.0942/kWh. The optimal long-term system is a PV/geothermal generator /V2G/ converter, the NPC of the optimal system is approximately $47.7B, and the COE of the system is approximately $0.078/kWh. Energy bill and carbon emissions can both be cut sharply for the city if it adopts these new types of renewable energy dominated systems.

Genomic analysis of inbreeding level, kinship and breed relationships in Creole cattle from South America.

The conservation of animal genetic resources refers to measures taken to prevent the loss of genetic diversity in livestock populations, including the protection of breeds from extinction. Creole cattle populations have suffered a drastic reduction in recent decades owing to absorbent crosses or replacement with commercial breeds of European or Indian origin. Genetic characterization can serve as a source of information for conservation strategies to maintain genetic variation. The objective of this work was to evaluate the levels of inbreeding and kinship through the use of genomic information. A total of 903 DNAs from 13 cattle populations from Argentina, Bolivia and Uruguay were genotyped using an SNP panel of 48 K. Also, a dataset of 76 K SNPs from Peruvian Creole was included. Two inbreeding indices (FROH and Fhat2) and kinship relationships were calculated. In addition, effective population size (Ne), linkage disequilibrium, population composition and phylogenetic relationships were estimated. In Creole cattle, FROH ranged from 0.14 to 0.03, and Fhat2 was close to zero. The inferred Ne trends exhibited a decline toward the present for all populations, whereas Creole cattle presented a lower magnitude of Ne than foreign breeds. Cluster analysis clearly differentiated the taurine and Zebu components (K2) and showed that Bolivian Creole cattle presented Zebu gene introgression. Despite the population reduction, Creole populations did not present extreme values of consanguinity and kinship and maintain high levels of genetic diversity. The information obtained in this work may be useful for planning conservation programmes for these valuable local animal genetic resources.

Land-Water-GHG-Food Nexus performance and physical-socio-economic-policy factors influencing rice cultivation in Central Thailand

Agriculture activity contributes to greenhouse gas (GHG) emissions through its utilization of land, water, and energy for food production. Hence, the interactions between land, water, and GHG emissions in agricultural production need to be comprehensively studied. The study aimed to assess the Land-Water-GHG-Food Nexus Index (LWGFNI) of rice cultivation across various land suitability classes in Central Thailand and determining the physical, socio-economic, and policy factors that can influence farmers' decisions to choose for cultivating rice instead of shifting to other crops. The results indicated that the highest LWGFNI score was 0.69 for the rice grown in the moderate suitability land class which revealed a lower use of land and water resources as well as GHG emissions compared to other levels of land suitability. The LWGFNI scores of major rice cultivation were greater compared to the second rice in all four-land suitability. The use of fertilizers had a crucial role in enhancing productivity levels and was a significant factor in the generation of GHG emissions. Hence, improving effective production should consider the appropriate use of fertilizer. The physical, socio-economic, and policy-related aspects that significantly influenced farmers' decisions on cultivation of rice included topography, water resources, inherited professions, price guarantee, and knowledge/training factors. The methodology used and results obtained can help policy makers to plan the use of water and land resources efficiently and appropriately with local resources based on land suitability class. The assessment results revealed the GHG hotspots and the strategies to mitigate GHG emissions associated with rice cultivation.

Developing classroom ICT teaching techniques, principles and practice for teachers in rural Ghana without access to computers or internet: a framework based on literature review

PurposeThis paper aims to propose a conceptual framework for integrating information and communication technologies (ICT) into teaching practices for educators in rural Ghana lacking computer and internet access. Bridging the rural–urban digital divide is critical for equitable quality education. This research identifies distinct infrastructure, financial, human, and socio-cultural challenges of ICT adoption in underserved Ghanaian schools through an exhaustive literature review. The framework provides tailored strategies to empower teachers to leverage ICT for innovative pedagogy despite limitations. Ultimately, the goal is to offer pragmatic, evidence-based solutions to advance ICT-enabled instruction and digital equity in marginalized settings.Design/methodology/approachThis study utilizes a qualitative literature review methodology to develop a conceptual framework for ICT teaching techniques tailored to the rural Ghanaian context. Published empirical studies, theoretical papers, and reports focused on ICT education in developing countries, particularly sub-Saharan Africa, were systematically reviewed across multidisciplinary databases. Relevant theories and models, like TPACK and SAMR, were analyzed to determine appropriate modifications for the framework design. The proposed strategies emphasize affordable technologies, teacher training, localized content, and culturally relevant pedagogies selected based on evidence from literature to address the unique barriers and needs of the rural setting.FindingsThe literature review revealed profound infrastructure, financial, human, and socio-cultural barriers to ICT adoption in rural Ghanaian schools. These include lack of electricity, internet, hardware, and software alongside inadequate teacher training and support. The proposed conceptual framework offers solutions including leveraging low-cost technologies like mobile devices, prioritizing teacher professional development, developing localized digitally-enabled resources, and fostering community participation. Culturally relevant pedagogies are also emphasized. This tailored, evidence-based approach holds promise for enhancing ICT-enabled instruction and bridging digital divides to promote equitable quality education. Further findings will emerge through framework implementation and evaluation.Research limitations/implicationsThis conceptual framework requires implementation and evaluation to truly determine its impact and effectiveness in the intended rural Ghanaian context. As a literature review, primary data collection was not undertaken. Practical application of the framework in schools can yield direct insights through surveys, interviews, observations, and analysis of key educational outcomes pre and post-implementation. Comparisons with control groups may further illuminate its efficacy. Monitoring and adaptation over time is also essential. Ultimately, this research sets the foundation for praxis-oriented work transforming ICT integration in marginalized communities to advance digital equity and inclusion.Practical implicationsThis research provides an evidence-based, context-aware framework with pragmatic solutions to enhance ICT-enabled teaching and learning in underserved rural Ghanaian schools. It offers guidance to teachers, administrators, and policymakers on integrating technology despite infrastructure and resource constraints. The emphasis on cost-effective innovations, educator training, localized content, and community participation can inform planning and investments in ICT education. Broader applications include adapting the framework for other developing country contexts facing comparable challenges. Overall, this work promotes digital equity and quality education access, catalyzing social development and aligning with the UN Sustainable Development Goals.Social implicationsThis research highlights the urgent need to address digital divides exacerbating educational inequalities between rural and urban communities in Ghana. Lack of technology access and utilization in rural schools threatens to widen gaps in skills, capabilities, and opportunities for students. Strategic integration of ICT can promote social inclusion, cultivate digital literacy, and equip youth to participate in the global digital economy, thereby enhancing prospects. More broadly, advancing digital equity and ICT-enabled education empowers marginalized groups, fosters community empowerment, and drives progressive social change. This work underscores that localized, context-appropriate solutions are pivotal for promoting development and social justice.Originality/valueThis research fills a crucial gap by proposing a conceptual framework tailored specifically for integrating ICT in teaching practices in rural Ghanaian schools lacking digital access, responding to context-specific barriers and needs. While extensive literature examines ICT education models globally, few studies offer localized strategies for resource-constrained environments. This framework adapts established models based on a systematic literature review, emphasizing affordability, capacity building, and cultural relevance. By synthesizing evidence-based, pragmatic solutions to advance ICT-enabled instruction in marginalized settings, this work provides a valuable foundation for praxis transforming rural education. The localization approach could inform frameworks for other developing regions.

Evaluation of urban ecological security model based on GIS sensing and MCR model

Urban ecological security is not only a basic safety requirement for human security and development, but also an important part of national security and other security and infrastructure carriers. Protecting the environment is an important factor in the construction of China's natural civilization. In recent years, with the deterioration of the environment, the region and its people have paid more and more attention to the safety of urban ecological environment, which has become one of the hottest issues in current research. Land use/cover rate change (LUCC) affects the environment, which will also affect environmental safety, and changes in its appearance will also affect nature and the environment, providing a positive impetus for the control of natural processes. In this paper, researches on the above problems in City K and Zhengzhou are carried out, using MSPA and visual image forms to better connect local resources, and through the MCR model based on ecological control, a weight-based multi-structure network model is established, which is conducive to the establishment of a multi-structure network model based on ecological control. Build a city of environmental science network. The GIS control line was explored, and the concept of the control line was filled to a certain extent. At the same time, taking City K and Zhengzhou as examples, determining the breadth of their layout and management, as well as the control strategy of their environmental control lines, provides a specific reference angle for the layout and research of other cities. Urban ecological security is very important to each of us living in cities. It is a difficult problem at this stage to establish an ecological security model to open a new security pattern.

Fiscal Devolution and Healthcare Accessibility A Case Study of Homa Bay County

Fiscal devolution has gained prominence as a policy approach in many developing countries, aiming to enhance healthcare accessibility. This study focused on the influence of Fiscal devolution on healthcare accessibility in Homabay County. The study employed a mixed-methods approach to assess the impact of fiscal devolution on public sector efficiency, combining quantitative data analysis and qualitative observations. With an emphasis on metrics like service quality, punctuality, and accessibility, quantitative data were gathered via questionnaires and administrative records. Key stakeholders, such as representatives of the local government, prominent members of the community, and recipients of services, were interviewed in-depth and participated in focus groups to get qualitative data. The data were analyzed using appropriate SPSS version 27 statistical techniques and thematic analysis to identify patterns and relationships. Results showed that fiscal devolution had both positive as well as negative effects on healthcare accessibility in Homabay County, underlining the importance of effective local government and resource allocation processes. Preliminary data indicate that fiscal devolution in Homabay County has had a mixed effect on healthcare accessibility. On one hand, decentralization has empowered local authorities to make decisions tailored to local needs, resulting in improved service responsiveness and community engagement. On the other hand, challenges related to inadequate financial resources, capacity constraints, and intergovernmental coordination have hindered the efficient delivery of public services. Effectiveness of fiscal devolution largely depends on the presence of effective local governance structures, transparent resource allocation mechanisms, and capacity building initiatives.

E-commerce and foreign direct investment: pioneering a new era of trade strategies

This study explores the dynamic interplay between foreign direct investment, e-commerce, and China’s export growth from 2005 to 2022 against the backdrop of the rapidly evolving global economy. Utilizing advanced analytical models that combine province- and year-fixed effects with fully modified ordinary least squares and dynamic ordinary least-squares methodologies, we delve into how foreign direct investment and e-commerce collectively boost China’s export capabilities. Our findings highlight a significant alignment between China’s export expansion and the global sustainable development agenda. We observe that China’s export growth transcends mere international investment and digital market engagement, incorporating sustainable practices such as effective utilization of local labor resources and an emphasis on technological advancements. This study also uncovers how knowledge capital and educational attainment positively impact export figures. A notable regional disparity is observed, with the eastern regions of China being more responsive to foreign direct investment and e-commerce influences on export trade compared to their western counterparts. This disparity underscores the need for region-specific policy approaches and sustainable strategies to evenly distribute the benefits of foreign direct investment and e-commerce. The study concludes that while foreign direct investment and e-commerce are crucial for China’s export growth, the underlying theme is sustainable development, with technological innovation and human capital being key to ongoing export success. The findings advocate for policies that balance economic drivers with sustainable development goals, ensuring both economic prosperity and environmental sustainability.

Genetic Landscape of Hearing Loss in the Caribbean: A Narrative Review.

The Caribbean region has a diverse population of about 40 million people, spread over 13 sovereign states. This review aims to describe the existing studies on hereditary hearing loss (HL) in the Caribbean population. We systematically reviewed scientific articles on HL prevalence, genetic causes, technology use, and environmental effects in Caribbean nations and the Caribbean diaspora in the United States. Key findings show that HL rates, with diverse genetic variables, vary across Puerto Rico, Cuba, and the Dominican Republic. Local resources and technology have been used to diagnose HL, particularly in rural areas. Environmental factors tend to affect HL prevalence in various regions. This literature review of Caribbean-focused studies helps guide future research and healthcare strategies, particularly concerning genetic drift caused by migration to the United States. Understanding these factors can help diagnose and treat HL in America's diverse population.

ACTOR SYNERGITYTRIPLE HELIX IN SMART TOURISM: THE FRAMEWORK OF THE SMART VILLAGE IN THE DEVELOPMENT POLICY OF TOURIST VILLAGES IN LAMPUNG PROVINCE

Purpose: The development of digital era tourism has become the main trend related to the development of tourism based on smart tourism. The synergy of the triple helix actors, namely the Government, the community and young people (millennials) in order to support the successful implementation of smart tourism is the main key apart from infrastructure issues and qualified technological support.   Theoretical Framework: The hope of conducting this research is to map out in detail the smart village from the point of view of the functions of the government, society, and the millennial generation in smart tourism in Trimulyo Village, West Lampung Regency. The smart village concept is a collaborative use of digital technology, community empowerment and sustainable development in the context of development in rural areas. Within this framework, the Triplehelix actors who are the main subjects of this research are actively involved in decision making, developing a creative economy based on local wisdom, and developing sustainable resources.   Methods: This research is supported and studied with a descriptive qualitative method. All information is collected from the results of interviews, field observations and document analysis.   Results: This research presents important documents from a smart village, including education and training, digital-based infrastructure, local economic development and sustainable resource management. The results of this study are the involvement of Triplehelix actors in smart villages showing positive results, including the creation of sustainable, smart and empowering tourist destinations.   Conclusions: This research makes an important contribution to understanding how the smart village framework increases the participation of Triplehelix actors in smart tourism in Trimulyo Village, Gedung Surian District, West Lampung Regency.

Decolonizing the Teaching and Learning of Indigenous Nguni Music Instruments in Higher Institutions of Learning in South Africa

This is an ethnographic study which was carried out to determine appropriate and effective models, approaches, strategies and techniques, for the transmission of Indigenous African Music (IAM), as practised in the communities of Tsembeyi village in the Eastern Cape Province and Impunga Village in KwaZulu-Natal Province of South Africa to the institutions of higher learning. The research explored pedagogical intervention measures for transplanting the teaching and learning of indigenous Nguni music instruments at Walter Sisulu University. This enquiry is underpinned by the praxial and Ubuntu theories, which ensure that participants are practically involved in doing, making, and experiencing learning as a collective. The study adopted an interpretive paradigm entrenched in a qualitative approach. Semi-structured interviews and participant observation were administered to collect data from 13 preservice music teachers including the main researcher and 3 community music experts drawn from the amaXhosa and AmaZulu, who are part of the Nguni nation in the Eastern Cape, and KwaZulu-Natal provinces. The thematic analysis revealed that the importance of engagement of the community in teaching and learning Nguni music instruments, underlying philosophical knowledge, and the understanding and approach to the construction and playing of IAM instruments. The authors argue for the possibility of breaking down the barriers of marginalization, and discrimination and celebrating human capabilities through the use of local resources and engagement of the community, thus, striking a meaningful and appropriate balance between the approaches that are used in traditional communities and institutions of higher learning. Keywords: Decolonization, Transmission, Curriculum, Indigenous African Music, and Nguni.

Statistical downscaling of GRACE terrestrial water storage changes based on the Australian Water Outlook model

The coarse spatial resolution of the Gravity Recovery and Climate Experiment (GRACE) dataset has limited its application in local water resource management and accounting. Despite efforts to improve GRACE spatial resolution, achieving high resolution downscaled grids that correspond to local hydrological behaviour and patterns is still limited. To overcome this issue, we propose a novel statistical downscaling approach to improve the spatial resolution of GRACE-terrestrial water storage changes (ΔTWS) using precipitation, evapotranspiration (ET), and runoff data from the Australian Water Outlook. These water budget components drive changes in the GRACE water column in much of the global land area. Here, the GRACE dataset is downscaled from the original resolution of 1.0° × 1.0° to 0.05° × 0.05° over a large hydro-geologic basin in northern Australia (the Cambrian Limestone Aquifer—CLA), capturing sub- grid heterogeneity in ΔTWS of the region. The downscaled results are validated using data from 12 in-situ groundwater monitoring stations and water budget estimates of the CLA’s land water storage changes from April 2002 to June 2017. The change in water storage over time (ds/dt) estimated from the water budget model was weakly correlated (r = 0.34) with the downscaled GRACE ΔTWS. The weak relationship was attributed to the possible uncertainties inherent in the ET datasets used in the water budget, particularly during the summer months. Our proposed methodology provides an opportunity to improve freshwater reporting using GRACE and enhances the feasibility of downscaling efforts for other hydrological data to strengthen local-scale applications.

Canadian colorectal cancer screening programs: How do they measure up using the International Agency for Research on Cancer criteria for organized screening?

Abstract Background Canada has one of the highest incidences of colorectal cancer (CRC) worldwide. CRC screening improves CRC outcomes and is cost-effective. This study compares Canadian CRC screening programs using essential elements of an organized screening program outlined by the International Agency for Research on Cancer (IARC). Methods We collaborated with the Cancer Screening in 5 continents (CanScreen5) program, an initiative of IARC. Standardized data collection forms were sent to representatives of provincial and territorial CRC screening programs. Twenty-five questions were selected to reflect IARC’s essential elements of an organized screening program. We performed a qualitative analysis of Canada’s CRC screening programs and compared programs within Canada and internationally. Results CRC screening programs exist in 10 provinces and 2 territories. None of the programs in Canada met all the essential criteria of an organized screening program outlined by IARC. Three programs do not send invitations to participate in screening. Among those that do, 4 programs do not include a stool test kit in the invitations. While all provinces met the essential elements for leadership, governance, finance, and access to essential services, there was more heterogeneity in the domains of service delivery as well as information systems and quality assurance. Conclusions There is considerable heterogeneity in the design of CRC screening programs in Canada and worldwide. Programs should strive to meet all the essential IARC criteria for organized screening if local resources allow, such as issuing invitations and implementing systems to track and compare outcomes to maximize screening program quality, effectiveness, and impact.

Flow-Through Procedure in Sequela After Complex Injuries of the Hand With Fingers’ Amputation

PurposeComplex injuries of the hand with finger amputation can result in important functional impairment. If the amputated fingers cannot be replanted, the developed sequelae should be further evaluated. Sometimes, in the presence of a few remaining local vascular resources, the use of the flow-through technique can help in solving the problem. MethodsThis study retrospectively reviews 4 cases who underwent single or multiple fingers reconstruction with toe transfers by using true flow-through or flow-through conduit flaps. A thorough description of the two methods is done, and the quality of the regained functionality of the hand is presented. ResultsAll the patients were males, aged between 21 and 45 (median age 31.75). One of them injured the left dominant hand, and the other three their right dominant hand. The median time between the accident and reconstructive surgery was 14.5 months (range, 3 months-36 months). All the initial lesions were work-related trauma. One patient had severe sequela after forearm compartment syndrome and amputation of the thumb and fifth finger; one patient had a metacarpal hand, one patient had amputation of two fingers (2nd and 4th); and one patient had three fingers amputated (2nd, 3rd, and 4th). In the first patient, a true flow-through flap and a second toe transfer was done, and in the other three patients multiple toe transfers by using the flow-through conduit technique were used. A good functionality of the reconstructed hand was obtained in all the patients. ConclusionsToe transfer remains one of the best methods in the reconstruction of hands with missing fingers. The use of both true flow-through flap and flow-through conduit methods are very useful, especially in cases with few vascular resources.

Groundwater: Sinking Cities, Urbanisation, Global Drying, Population Growth

An examination of a few examples of aquifer-use shows the importance and fragility of groundwater, with poor management leading to over-extraction by individuals and authorities producing subsidence – sinking cities. Freshwater is one of our most precious resources and it is rapidly disappearing, leading to global drying. At the same time, the global and urban populations are increasing, with civil unrest increasing due, in part, to freshwater shortages. The increasing global population and global urbanisation are driving an increase in water use, restriction of aquifer recharge and increased aquifer pollution. It is argued that urban population growth with attendant increased water use, combined with climate change and poor management, is significant in water stress. Particular attention must be paid to the effect of rising populations on local water resources, especially groundwater, and the knock-on effect on urban sustainability.