Term Retention Research Articles

A three-tier framework for monitoring antiretroviral therapy in high HIV burden settings.

The provision of antiretroviral therapy (ART) in low and middle-income countries is a chronic disease intervention of unprecedented magnitude and is the dominant health systems challenge for high-burden countries, many of which rank among the poorest in the world. Substantial external investment, together with the requirement for service evolution to adapt to changing needs, including the constant shift to earlier ART initiation, makes outcome monitoring and reporting particularly important. However, there is growing concern at the inability of many high-burden countries to report on the outcomes of patients who have been in care for various durations, or even the number of patients in care at a particular point in time. In many instances, countries can only report on the number of patients ever started on ART. Despite paper register systems coming under increasing strain, the evolution from paper directly to complex electronic medical record solutions is not viable in many contexts. Implementing a bridging solution, such as a simple offline electronic version of the paper register, can be a pragmatic alternative. This paper describes and recommends a three-tiered monitoring approach in low- and middle-income countries based on the experience implementing such a system in the Western Cape province of South Africa. A three-tier approach allows Ministries of Health to strategically implement one of the tiers in each facility offering ART services. Each tier produces the same nationally required monthly enrolment and quarterly cohort reports so that outputs from the three tiers can be aggregated into a single database at any level of the health system. The choice of tier is based on context and resources at the time of implementation. As resources and infrastructure improve, more facilities will transition to the next highest and more technologically sophisticated tier. Implementing a three-tier monitoring system at country level for pre-antiretroviral wellness, ART, tuberculosis and mother and child health services can be an efficient approach to ensuring system-wide harmonization and accurate monitoring of services, including long term retention in care, during the scale-up of electronic monitoring solutions.

Enhancing the Education and Understanding of Research in Community Health Workers in an Intervention Field Site in South India

Background : Community-level public health research engages a wide range of staff cadres. Community level workers with limited formal education are usually in first contact with the community and require training so that research interventions are carried out to high standards. Method : In a community-based TB study in South India, a Professional Development Programme (PDP) was developed to optimize the quality of the research, and to make involvement in research more meaningful for all members of the research team. The programme started with a set of modules that were considered relevant for a community-based epidemiological study. Subsequently, new modules were developed based on the expressed needs of the study staff. Pre and post-tests were conducted for all modules. A qualitative assessment was conducted after 3 years. Results : While initial 'pre-test' knowledge across modules was lower amongst community level field workers than staff of higher cadres, they achieved passing grade scores (>75%) with the programme. Longer term retention of knowledge over 6 months for the basic modules, was in excess of 75% for all staff. Focus groups discussions revealed that while many in the research team began work with an incomplete understanding of research methods and community health principles, investing time and resources in education beyond protocol training via the PDP realized long-term benefits to the research study and the individual staff, particularly the community level workers. Conclusions : There is a need to enhance the capabilities of community health workers to be part of a research team in field settings, so as to optimize their performance while utilizing their existing skill sets.

Toll-like Receptor Agonists Promote Prolonged Triglyceride Storage in Macrophages

Macrophages in infected tissues may sense microbial molecules that significantly alter their metabolism. In a seeming paradox, these critical host defense cells often respond by increasing glucose catabolism while simultaneously storing fatty acids (FA) as triglycerides (TAG) in lipid droplets. We used a load-chase strategy to study the mechanisms that promote long term retention of TAG in murine and human macrophages. Toll-like receptor (TLR)1/2, TLR3, and TLR4 agonists all induced the cells to retain TAG for ≥3 days. Prolonged TAG retention was accompanied by the following: (a) enhanced FA uptake and FA incorporation into TAG, with long lasting increases in acyl-CoA synthetase long 1 (ACSL1) and diacylglycerol acyltransferase-2 (DGAT2), and (b) decreases in lipolysis and FA β-oxidation that paralleled a prolonged drop in adipose triglyceride lipase (ATGL). TLR agonist-induced TAG storage is a multifaceted process that persists long after most early pro-inflammatory responses have subsided and may contribute to the formation of "lipid-laden" macrophages in infected tissues.

500

Introduction: Code teams respond to cardiopulmonary arrest (CPA) events and must be able to act immediately as a team to effectively manage these emergencies. Teamwork amongst the code team during these responses are critical for efficient and effective resuscitation actions. Code team members are trained and skilled to respond to CPA events, but are often deficient in teamwork skills during resuscitation. Findings from previous research at the study organization to assess teamwork perception by code team members showed deficits in perception of teamwork related to leadership, communication, and mutual team support. The purpose of this study was to determine the effect of a two-hour training program using simulation, debriefing, and review of Crew Resource Management principles related to CPA events on perception of teamwork of code team members. Methods: The study was conducted in one large tertiary teaching hospital. Code team members who routinely respond to CPA events were invited to participate in a two-hour teamwork training program. A pre-test, post-test design was used for the study. A sample of resident physicians (MDs), nurses (RNs), and respiratory therapists (RTs) participated in a two-hour teamwork training program for CPA events. After informed consent, subjects participated in a mock CPA event in a simulation lab while being evaluated for teamwork skills by trained observers. After the simulation, subjects and observers rated teamwork performance during the simulation using the Team Emergency Assessment Measure (TEAM) tool on a 1–4 scale, including a global rating (1–10 scale). Next, a debriefing of the event was done, followed by a didactic presentation with group discussion on teamwork skills during CPA emergencies, using Crew Resource Management and TeamSTEPPS principles. Key areas of emphasis were on leadership, communication, and mutual support during CPA events. Subjects then participated in a second simulation of a different CPA event and were encouraged to use principles they had just learned in the program. Immediately following, subjects and observers again rated teamwork performance using the TEAM tool and completed evaluations on the program. Results: Seventy-three code team members participated in the study: 18 MDs (25%), 23 RNs (32%), and 30 RTs (41%) in small groups over a 12 week period. Significant improvement in the average TEAM score was noted by both participants and observers after the teamwork training program. Participants’ mean TEAM pre-test score was 3.3 and post-test score was 3.7 (p<.001) on a 1–4 scale. Observers’ mean scores improved from 3.0 to 3.7 (p<.001). Participants’ global rating score (1–10 scale) increased from 7.7 to 8.8 (p<.001) and observers’ global rating scores increased from 7.3–9.0 (p<.001). While observers rated the TEAM scores significantly lower than those of participants on the 1st simulated event, no differences were found after the 2nd simulation evaluation or on either of the global ratings (p<.05) Participants rated the simulation and training program as being beneficial, effective, enjoyed interprofessional team learning, and supported incorporating team training in future CPA training. Conclusions: A two-hour teamwork training program incorporating simulation and teamwork principles improves perceptions of teamwork from both trained observers and code team members. It was possible to incorporate teamwork principles into a two-hour training session versus a longer workshop program on team training. The program was effective in conveying key concepts relating to teamwork during CPA events in an interprofessional learning environment and participants were able to learn from each other, respecting contributions and roles from members of the code team. While long term retention of concepts and sustainability was not assessed in this study, a potential area for study on how team training for CPA events translates into behaviors during actual CPA emergencies may enhance knowledge in this area of practice.

Effect of Interleaving Exemplars Presented as Auditory Text on Long- term Retention in Inductive Learning

The present study investigated the exemplar interleaving effect on long-term retention in the context of inductive learning. In particular, an experiment using aurally presented texts was conducted to examine whether or not the benefits of interleaving of exemplars from several categories vary with retention interval in inductive learning. Participants studied a series of aurally presented texts from several categories which were presented massed and interleaved, and later their induction was tested either shortly after the study phase (short-term retention) or after a week‘s delay (long-term retention). Consistent with findings from previous studies, the interleaving effect was found in the short-term retention condition, and crucially, the present study extended the generalisability of the interleaving effect in the long-term retention condition to aurally presented texts. Interestingly, participants judged massing to be more effective than spacing (interleaving) though their actual performance showed the opposite. The present study provides further evidence that interleaved exemplars have considerable potential in improving inductive learning in the long term.

Generalizing automated detection of the robustness of student learning in an intelligent tutor for genetics.

Recently, there has been growing emphasis on supporting robust learning within intelligent tutoring systems, assessed by measures such as transfer to related skills, preparation for future learning, and longer term retention. It has been shown that different pedagogical strategies promote robust learning to different degrees. However, the student modeling methods embedded within intelligent tutoring systems remain focused on assessing basic skill learning rather than robust learning. Recent work has proposed models, developed using educational data mining, that infer whether students are acquiring learning that transfers to related skills, and prepares the student for future learning (PFL). In this earlier work, evidence was presented that these models achieve superior prediction of robust learning to what can be achieved by traditional methods for student modeling. However, using these models to drive intervention by educational software depends on evidence that these models remain effective within new populations. To this end, we analyze the degree to which these detectors remain accurate for an entirely new population of high school students. We find limited evidence of degradation for transfer. More degradation is seen for PFL. This degradation appears to occur in part because it is generally more difficult to infer this construct within the new population.

The effect of random or sequential presentation of targets during robot-assisted therapy on children

Robot assisted upper extremity therapy has been shown to be effective in adult stroke patients and in children with cerebral palsy (CP) and other acquired brain injuries (ABI). The patient's active involvement is a factor in its efficacy. However, this demands focused attention during training sessions, which can be a challenge for children. To compare results of training requiring two different levels of focused attention. Differences in short term performance and retention of gains as a function of training protocol as measured by the Fugl-Meyer (FM) were predicted. Thirty-one children with CP or ABI were randomly divided into two groups. All received 16 one hour sessions of robot-assisted therapy (twice a week for 8 weeks) where they moved a robot handle to direct a cursor on the screen toward designated targets. One group had targets presented sequentially in clockwise fashion, the other presented in random order. Thus, one group could anticipate the position of each target, the other could not. Both groups showed significant functional improvement after therapy, but no significant difference between groups was observed. Assist-as-needed robotic training is effective in children with CP or ABI with small non-significant differences attributed to attentional demand.

Therapeutic angiogenesis by a myoblast layer harvested by tissue transfer printing from cell-adhesive, thermosensitive hydrogels

Peripheral arterial disease (PAD) is characterized by the altered structure and function of arteries caused by accumulated plaque. There have been many studies on treating this disease by the direct injection of various types of therapeutic cells, however, the low cell engraftment efficiency and diffusion of the transplanted cells have been major problems. In this study, we developed an approach (transfer printing) to deliver monolayer of cells to the hindlimb ischemic tissue using thermosensitive hydrogels, and investigated its efficacy in long term retention upon transplantation and therapeutic angiogenesis. We first investigated the in vitro maintenance of robust cell–cell contacts and stable expression of the ECM proteins in myoblast layer following transfer printing process. In order to confirm the therapeutic effect of the myoblasts in vivo, we cultured a monolayer of C2C12 myoblasts on thermosensitive hydrogels, which was then transferred to the hindlimb ischemia tissue of athymic mice directly from the hydrogel by conformal contact. The transferred myoblast layer was retained for a longer period of time than an intramuscularly injected cell suspension. In addition, the morphology of the mice and laser Doppler perfusion (28 days after treatment) supported that the myoblast layer enhanced the therapeutic effects on the ischemic tissue. In summary, the transplantation of the C2C12 myoblast layer using a tissue transfer printing method could represent a new approach for the treatment of PAD by therapeutic angiogenesis.

Rehabilitating Seagrass by Facilitating Recruitment: Improving Chances for Success

AbstractAttempts to arrest seagrass loss through numerous rehabilitation methods have traditionally produced inconsistent results. On Australia's southern coast, hessian bags made from biodegradable jute fibers show promise for rehabilitating Amphibolis antarctica by facilitating recruitment of seedlings in situ. Testing ways to improve the performance of bags (i.e. increasing seagrass recruitment and establishment) showed that bags with a coarse outer weave of hessian facilitated greater seedling densities (approximately 1700 individuals/m2) than bags with a fine outer weave, but the content of bags (sand vs. sand and rubble mixture) had little effect. Isolated bags facilitated greater longer term densities than bags grouped together, while similar densities were sampled up to 80 m away from a natural meadow. Lastly, bags that had spent less time in situ initially facilitated more recruits than older bags, but longer term (21–32 months) retention was similar among bag ages. Collectively, the results suggest hessian bags can be a relatively simple, cost‐effective, and environmentally friendly method for rehabilitating Amphibolis seagrass, with few considerations in their use other than their physical architecture and arrangement (e.g. isolated coarse‐weave bags).

Úloha mzdy v motivaci a stabilizaci zaměstnanců finančního sektoru v České republice ve vztahu k Herzbergově teorii dvou dimenzí motivace k práci

The article deals with employee motivation and retention in the financial sector. The first part defines the terms motivation and retention and introduces the related theories - from the very beginning, through the classical theories and the contemporary modern theories. The article's author utilizes own extensive research among respondents coming from employees in the financial sector, supplemented by the round table method. The author analyzes the research results and deals with the role of wages in employee motivation - whether and when wage functions as a motivator leading to higher employee performance according to the Herzberg's two factor theory (an intrinsic needs motivator, i.e. satisfier) and when it is a factor, if positive, without influence on employee activity while if negative or absent, it causes employee dissatisfaction (a hygiene factor known as dissatisfier in the same theory). There are recommendations for organizational best practices shown at the end of the article.

The retention of personal information online: A call for international regulation of privacy law

New technologies permit online businesses to reduce expenses and increase efficiency by, for example, storing information in “the cloud”, engaging in online tracking and targeted advertising, location and tracking technologies, and biometrics. However, the potential for technology to facilitate long term retention of customers' personal information raises concerns about the competing right of individuals to the privacy of their personal information. Although the European Commission has recently released a proposal for regulation to “provide a data subject with the right to be forgotten and to erasure”, neither the OECD Privacy Guidelines nor the APEC Privacy Framework includes any requirement to delete personal information. While New Zealand includes a “limited retention principle” in the Privacy Act 1993, apart from one limited exception the privacy principles cannot be enforced in court. Taking New Zealand privacy law as an example, this paper examines the issue of retention of customer data, explains why this is a serious problem and argues that although it could be addressed by appropriate amendments to domestic laws, domestic privacy legislation may not be sufficient in an online environment. In the same way as other areas of law, such as the intellectual property regime, have turned to global regulatory standards which reflect the international nature of their subject matter, international privacy regulation should be the next stage for the information privacy regime.

Mucosal infection drives rapid development of protective resident memory CD8 T cells (P1444)

Abstract The intestinal mucosa contains unique sites designed for promoting specialized T cell responses. Oral infection with a murinized Listeria monocytogenes (Lm) induced a robust mucosal CD8 T cell response which rapidly converted to a memory population during the peak of the intestinal T cell response. Concomitant with this event, the mice were nearly completely protected against re-infection. Blocking migration with anti-α4β7 from 7 dpi prevented continued migration into the intestinal compartment but did not alter the rapid conversion of early migrating cells into memory suggesting in situ events regulated early memory formation. These early memory cells, but not other effector subsets, preferentially upregulated CD103 identifying them as precursors to mucosal resident memory CD8 T cells. Surprisingly, CD103 expression on infiltrating CD8 T cells was required for early T cell entry into the epithelium but not for long term retention. Moreover, CD103 upregulation on Lm-specific CD8 T cells within the epithelium was predominately independent of TGFβ signals. Thus, the generation of distinct CD8 T cell subsets uniquely tailored to respond to intestinal pathogens may be a hallmark of oral challenge. Indeed, CD8 T cells that infiltrate the intestinal mucosa following intranasal influenza virus infection failed to generate MPECs and were not maintained long-term, demonstrating the importance of intestinal priming for generating robust mucosal memory CD8 T cells.

Quirks of Stirling’s Approximation

Stirling’s approximation to ln n! is typically introduced to physical chemistry students as a step in the derivation of the statistical expression for the entropy. However, naïve application of this approximation leads to incorrect conclusions. In this article, the problem is first illustrated using a familiar “toy model” example, the two-state system of N classical spins, where it is shown that two different physical situations lead to the same computed value of the entropy. Retention of additional terms in the approximation of the factorial is required to yield an accurate expression for the statistical weight of the most probable configuration in such model systems, but generates only a little extra accuracy in entropy calculations, and then only in the limit of very small numbers of particles. Additionally, inclusion of these terms makes the entropy nonextensive. We show here that, in the standard derivation of the entropy of the microcanonical ensemble, it is the freedom to allow the ensemble size to be infinite that makes the Boltzmann entropy expression S = kB lnW exact, a fact that is not widely understood.

RESPONSE OF CENTELLA ASIATICA IN THE MANAGEMENT OF AGE RELATED PROBLEMS AMONG ELDERLY WITH SPECIAL REFERENCE TO COGNITIVE PROBLEMS AS PER PRAKRITI

Centella asiatica causes an overal l decrease in the yield of central monoamines, implicating the participation of nor epinephrine, dopamine and 5 - HT in learning and memory process towards long term retention of information. More recently, a new study showed that components in Centella asia tica have potential for treating Alzheimer’s disease and cognitive impairment . The study was designed to assess the effect of Centella asiatica on age related common health problem s as per constitution of individuals. Patients aged 60 years and above wer e enrolled from geriatric O.P.D. Mini Mental State Examination ( MMSE ) is the most important diagnostic tool for our study along with the history of patients. Present study has showed that s ignificant decrease in MMSE, blood pressure and sleeping disorders was observed in V ata and Pitta Prakriti individuals. In this study drug Centella asiatica wa s found to be highly effective in Mild cognitive impairment by improving the MMSE, Hypertension and sleeping pattern in elderly population.

Forecasting of Customers’ Retention In Terms of Merger and Acquisition Processes of Egyptian Banks Using Panel Data Techniques

This paper aims at analyzing the response of banks’ customers, due to changes of banking market structure, where many of these customers may switch their banks, and this is why, determinants of these decisions should be elaborated. In this study, the sample contains 6 cases, out of 20 cases of merger and acquisition processes (M&As) between Egyptian banks, during the period from the beginning of 2005 to the end of 2010. Using Panel Data Models, we could accept hypotheses regarding the effects of “Change in Bank Equity” and “Change in Bank Assets” on “Customers’ Retention”. Also, Results refer to the need to reject hypotheses regarding the effects of “Change in Bank Loans”, “Change in Bank Deposits, “Change in No. of Services” and Change in No. of Branches”. Wu-Hausman test, Likelihood Ratio test and Breusch-Pagan test justify these results.

Huge Anterior Sacral Meningocele Simulating Bladder Retention

Anterior sacral meningocele (ASM) is a rare congenital disorder involving herniation of the dural sac through a defect in the anterior surface of the sacrum. We report the case of a young patient with an enormous ASM that simulated bladder retention in terms of symptoms as well as on physical examination and at ultrasonography. After introducing a catheter that excluded urinary retention, computed tomography (CT) scan and magnetic resonance imaging (MRI) showed the ASM. The patient underwent surgical repair of the ASM through a sacral laminectomy and recovered normal lower urinary tract function.

Inductive Learning: Does Interleaving Exemplars Affect Long-Term Retention?

Purpose – The present study investigated whether or not the benefits of interleaving of exemplars from several categories vary with retention interval in inductive learning. Methodology – Two experiments were conducted using paintings (Experiment 1) and textual materials (Experiment 2), and the experiments used a mixed factorial design. Forty students participated in each experiment for course credit. In each experiment, participants studied a series of exemplars from several categories which were presented massed and interleaved, and later their induction was tested either shortly after the study phase (short-term retention) or after a week’s delay (long- term retention). Findings – Consistent with findings from previous studies, the interleaving effect was found in the short-term retention condition, and crucially, the present study provided the initial evidence that interleaving of exemplars also affected long-term retention. Interestingly, massing was judged to be more effective than spacing (interleaving) in most groups, even when actual performance showed the opposite. Significance – The present study shows that interleaved exemplars have considerable potential in improving inductive learning in the long term. For example, induction is used in case-based reasoning which requires one to start with learning from specifi c cases, and then form generalizations of these cases by identifying the commonalities between them. In order to enhance long-term retention, educators may want to consider using interleaved presentation rather than massed presentation in teaching examples or cases from a particular category or concept.

Timescales of learning in the basal ganglia and the hippocampus

Timescales of learning in the basal ganglia and the hippocampus

Short and long term retention in antiretroviral care in health facilities in rural Malawi and Zimbabwe

BackgroundDespite the successful scale-up of ART services over the past years, long term retention in ART care remains a major challenge, especially in high HIV prevalence and resource-limited settings. This study analysed the short (<12 months) and long (>12 months) term retention on ART in two ART programmes in Malawi (Thyolo district) and Zimbabwe (Buhera district).MethodsRetention rates at six-month intervals are reported separately among (1) patients since ART initiation and (2) patients who had been on ART for at least 12 months, according to the site of ART initiation and follow-up, using the Kaplan Meier method. ‘Retention’ was defined as being alive on ART or transferred out, while ‘attrition’ was defined as dead, lost to follow-up or stopped ART.ResultsIn Thyolo and Buhera, a total of 12,004 and 9,721 patients respectively were included in the analysis. The overall retention among the patients since ART initiation was 84%, 80% and 77% in Thyolo and 88%, 84% and 82% in Buhera at 6, 12 and 18 months, respectively. In both programmes the largest drop in ART retention was found during the initial 12 months on ART, mainly related to a high mortality rate in the health centres in Thyolo and a high loss to follow-up rate in the hospital in Buhera. Among the patients who had been on ART for at least 12 months, the retention rates leveled out, with 97%, 95% and 94% in both Thyolo and Buhera, at 18, 24 and 30 months respectively. Loss to follow-up was identified as the main contributor to attrition after 12 months on treatment in both programmes.ConclusionsTo better understand the reasons of attrition and adapt the ART delivery care models accordingly, it is advisable to analyse short and long term retention separately, in order to adapt intervention strategies accordingly. During the initial months on ART more medical follow-up, especially for symptomatic patients, is required to reduce mortality. Once stable on ART, however, the ART care delivery should focus on regular drug refill and adherence support to reduce loss to follow up. Hence, innovative life-long retention strategies, including use of new communication technologies, community based interventions and drug refill outside the health facilities are required.

Use of silver nanowires to determine thresholds for fibre length-dependent pulmonary inflammation and inhibition of macrophage migration in vitro.

BackgroundThe objective of this study was to examine the threshold fibre length for the onset of pulmonary inflammation after aspiration exposure in mice to four different lengths of silver nanowires (AgNW). We further examined the effect of fibre length on macrophage locomotion in an in vitro wound healing assay. We hypothesised that exposure to longer fibres causes both increased inflammation and restricted mobility leading to impaired clearance of long fibres from the lower respiratory tract to the mucociliary escalator in vivo.MethodsNine week old female C57BL/6 strain mice were exposed to AgNW and controls via pharyngeal aspiration. The dose used in this study was equalised to fibre number and based on 50 μg/ mouse for AgNW14. To examine macrophage migration in vitro a wound healing assay was used. An artificial wound was created in a confluent layer of bone marrow derived macrophages by scraping with a pipette tip and the number of cells migrating into the wound was monitored microscopically. The dose was equalised for fibre number and based on 2.5 μg/cm2 for AgNW14.ResultsAspiration of AgNW resulted in a length dependent inflammatory response in the lungs with threshold at a fibre length of 14 μm. Shorter fibres including 3, 5 and 10 μm elicited no significant inflammation. Macrophage locomotion was also restricted in a length dependent manner whereby AgNW in the length of ≥5 μm resulted in impaired motility in the wound closure assay.ConclusionWe demonstrated a 14 μm cut-off length for fibre-induced pulmonary inflammation after aspiration exposure and an in vitro threshold for inhibition of macrophage locomotion of 5 μm. We previously reported a threshold length of 5 μm for fibre-induced pleural inflammation. This difference in pulmonary and pleural fibre- induced inflammation may be explained by differences in clearance mechanism of deposited fibres from the airspaces compared to the pleural space. Inhibition of macrophage migration at long fibre lengths could account for their well-documented long term retention in the lungs compared to short fibres. Knowledge of the threshold length for acute pulmonary inflammation contributes to hazard identification of nanofibres.