Perception of final year undergraduate medical students towards family medicine in Dar es Salaam, Tanzania

Primary health care was identified as the ideal model of health care delivery during the Alma Atta conference in USSR in 1978. The World Health Organization urged member countries to adopt it as a model of health care service delivery to their people. Since then many countries have adopted a primary health care model including Tanzania. In countries such as Cuba and Costa Rica where primary health care has successfully been implemented, access to affordable and quality health care service to all has resulted in lowered morbidity, mortality, improved quality and longevity of life. The success story behind primary health care implementation in these countries has been attributed to family physicians taking a leading role. In 2008 the World Health Organization (WHO) challenged all countries to train more family physicians and emphasized the need to fully implement the primary health care model. Despite this call, there has been a decline in the number of doctors applying for family medicine residency programmes especially in developed countries and in Africa many countries are yet to start the training of family physicians. In Tanzania the Aga Khan University has been offering family medicine residency for more than five years. The number of local applicants to this program has remained low. To explore the reasons as to why this is the case, a qualitative study was designed. The study question was “what are the undergraduate medical students’ perceptions towards family medicine?” Methodology: This was a qualitative study carried out in two universities; Muhimbili University of Health and Allied Sciences (public) and the Hubert Kairuki Memorial University (private) among final year undergraduate medical students. A self-administered open-ended questionnaire was constructed, validated and used as the study tool to collect the data. The questionnaire was administered to all 212 final year undergraduate medical students in both institutions and the return rate was 84.5%. The questionnaires were administered by a research assistant at each institution. The final year class in each institution had four clinical rotation groups to which the questionnaire was administered and collected at different times. The answers of the open-ended questionnaire were treated as qualitative data (texts) and were analyzed through a data-led four-step method of analysis as described by Giorgi’s methods of analysis (1985). Themes were identified through the analysis and further validated through researcher triangulation. The study was approved by the Aga Khan University Ethics and Research Committee, Muhimbili University Research and Publication Committee and the Tanzania National Institute for Medical Research. Results: The gender distribution was 67% males and 33% females. 47% of the respondents had heard of family medicine while 53% had not. 36% of those who had heard of family medicine reported that they had had an exposure to a family physician. The exposures were through friends, family or at a private hospital. 40% of the females who had heard of family medicine said they would consider family medicine as a future career choice while only 17% of their male counterparts said they would consider family medicine. No significant difference in level of awareness was noted between the two universities. Among those respondents who had an awareness of family medicine two themes could be described. The first theme illustrates a profound lack of understanding of the role of family physician, described in three sections: The holistic doctor, the family doctor as serving special families only, and family medicine in the medical hierarchy and as a strategy for the health care system. Most of the students did not understand the concept of family medicine, for example some thought a family physician was a doctor for specific families/ special families, others thought (s)he dealt with family planning and hereditary diseases that run in families. Some did not understand how a family doctor differed from a medical officer. The second theme described that Personal competences and community needs are perceived as the main determinants of future career specialization. This theme is described in two sections showing that the professional and community needs come first, and that role modeling, professional status and accessibility are important determinants: Community needs, personal interest, personal skills, subject performance and role models were factors reported to influence how the students made future career decisions. Conclusion: The results show a general misinterpretation of the concept of family medicine, which is likely to influence the career choice among these future doctors. If family medicine is to be successfully introduced in Tanzania there will need to be interventions aimed at raising awareness of the role of family medicine within the health care system. Aga Khan University will need to increase awareness among medical students of the programme they offer. At the same time it will be important that other medical schools be encouraged to start family medicine programmes. Working with government to influence policy related to family medicine is also suggested as an important strategy for the future

Depth resolved snapshot energy-dispersive X-ray diffraction using a conical shell beam

We demonstrate a novel imaging architecture to collect range encoded diffraction patterns from overlapping samples in a single conical shell projection. The patterns were measured in the dark area encompassed by the beam via a centrally positioned aperture optically coupled to a pixelated energy-resolving detector. We show that a single exposure measurement of 0.3 mAs enables d-spacing values to be calculated. The axial positions of the samples were not required and the resultant measurements were robust in the presence of crystallographic textures. Our results demonstrate rapid volumetric materials characterization and the potential for a direct imaging method, which is of great relevance to applications in medicine, non-destructive testing and security screening

Delegation and caseload management in Occupational Therapy: team perspectives from the acute wards at Royal Devon University Healthcare NHS Foundation Trust Northern Services

#400WORDS: DELIVERING A RESEARCH SKILLED WORKFORCE SPECIAL EDITIO

Multivariate calibration of energy-dispersive X-ray diffraction data for predicting the composition of pharmaceutical tablets in packaging

A system using energy-dispersive X-ray diffraction (EDXRD) has been developed and tested using multivariate calibration for the quantitative analysis of tablet-form mixtures of common pharmaceutical ingredients. A principal advantage of EDXRD over the more traditional and common angular dispersive X-ray diffraction technique (ADXRD) is the potential of EDXRD to analyse tablets within their packaging, due to the higher energy X-rays used. In the experiment, a series of caffeine, paracetamol and microcrystalline cellulose mixtures were prepared and pressed into tablets. EDXRD profiles were recorded on each sample and a principal component analysis (PCA) was carried out in both unpackaged and packaged scenarios. In both cases the first two principal components explained >98% of the between-sample variance. The PCA projected the sample profiles into two dimensional principal component space in close accordance to their ternary mixture design, demonstrating the discriminating potential of the EDXRD system. A partial least squares regression (PLSR) model was built with the samples and was validated using leave-one-out cross-validation. Low prediction errors of between 2% and 4% for both unpackaged and packaged tablets were obtained for all three chemical compounds. The prediction capability through packaging demonstrates a truly non-destructive method for quantifying tablet composition and demonstrates good potential for EDXRD to be applied in the field of counterfeit medicine screening and pharmaceutical quality control

The Vulnverability Cube: A Multi-Dimensional Framework for Assessing Relative Vulnerability

The diversity and abundance of information available for vulnerability assessments can present a challenge to decision-makers. Here we propose a framework to aggregate and present socioeconomic and environmental data in a visual vulnerability assessment that will help prioritize management options for communities vulnerable to environmental change. Socioeconomic and environmental data are aggregated into distinct categorical indices across three dimensions and arranged in a cube, so that individual communities can be plotted in a three-dimensional space to assess the type and relative magnitude of the communities’ vulnerabilities based on their position in the cube. We present an example assessment using a subset of the USEPA National Estuary Program (NEP) estuaries: coastal communities vulnerable to the effects of environmental change on ecosystem health and water quality. Using three categorical indices created from a pool of publicly available data (socioeconomic index, land use index, estuary condition index), the estuaries were ranked based on their normalized averaged scores and then plotted along the three axes to form a vulnerability cube. The position of each community within the three-dimensional space communicates both the types of vulnerability endemic to each estuary and allows for the clustering of estuaries with like-vulnerabilities to be classified into typologies. The typologies highlight specific vulnerability descriptions that may be helpful in creating specific management strategies. The data used to create the categorical indices are flexible depending on the goals of the decision makers, as different data should be chosen based on availability or importance to the system. Therefore, the analysis can be tailored to specific types of communities, allowing a data rich process to inform decision-making

Rayleigh scattered photons for substance identification

Available from British Library Document Supply Centre-DSC:DXN006780 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo