The World Health Organization’s Ninth Director-General: The Leadership of Tedros Adhanom

In May, the World Health Assembly elected Tedros Adhanom Ghebreyesus as its ninth Director-General, the first African to lead the World Health Organization (WHO) since its formation in 1948. Dr. Tedros faces a daunting task, with WHO facing a crisis of confidence after its much-maligned response to the West African Ebola epidemic. Does his leadership record bode well for the Organization’s future success? That success is vital to world health, as WHO alone has the international legitimacy to forge cooperative solutions to complex health challenges. Dr. Tedros’s record offers a sharp contrast between promise and peril for the Organization. As health minister for Ethiopia, Dr. Tedros forged unprecedented gains in population health; nevertheless, his country’s human rights record was abysmal during this same time period. In a new Milbank Quarterly Early View op-ed, Lawrence O. Gostin explains that WHO is currently in an unvirtuous cycle. Member states have lost confidence in the Organization, while donors refuse to fully fund it, leading to additional dysfunction and failure. If Dr. Tedros is to succeed, he must regain badly eroded trust—not only among member states, but also among civil society

The role of secondary cyclones and cyclone families for the North Atlantic storm track and clustering over western Europe

Secondary cyclones are those that form in association with a pre‐existing primary cyclone, typically along a trailing cold front. In previously studied cases they have been shown to cause extreme damage across Europe, particularly when multiple cyclones track over the same location in rapid succession (known as cyclone clustering). To determine the dynamical relationship between primary and secondary cyclones over the North Atlantic, a frontal identification algorithm is partnered with a cyclone identification method to objectively identify secondary cyclones in 35 extended winter periods using reanalysis data. Cyclones are grouped into “cyclone families” consisting of a single primary cyclone and one or more secondary cyclones. This paper aims to quantify the differences between secondary and primary cyclones over the North Atlantic, and how cyclone families contribute to episodes of cyclone clustering across western Europe. Secondary cyclones are shown to occur most frequently in the central and eastern North Atlantic, whereas primary cyclones are commonly found over the western North Atlantic. Cyclone families have their strongest presence over the North Atlantic Ocean and contribute more than 50% of cyclones over the main North Atlantic storm track. A final category, solo cyclones, which are not associated with cyclogenesis on any connected fronts, are most commonly identified over continental regions as well as the Mediterranean Sea. Primary cyclones are associated with the development of an environment that is favourable for secondary cyclone growth. Enhanced Rossby wave breaking following primary cyclone development leads to an increase in the upper‐level jet speed and a decrease in low‐level stability. Secondary cyclogenesis commonly occurs in this region of anomalously low stability, close to the European continent. During periods of cyclone clustering, secondary cyclones are responsible for approximately 50% of the total number of cyclones. The increase in jet speed and decrease in static stability initiated by the primary cyclones acts to concentrate the genesis region of secondary cyclones and direct the cyclones that form along a similar track. While there is an increase in the secondary cyclogenesis rate near western Europe during periods of European clustering, the basin‐wide secondary cyclogenesis rate decreases during these periods. Thus the large‐scale environment redistributes secondary cyclones during periods of clustering rather than increasing the total number of secondary cyclones

Eddy Lifetime, Number, and Diffusivity and the Suppression of Eddy Kinetic Energy in Midwinter

The wintertime evolution of the North Pacific storm track appears to challenge classical theories of baroclinic instability, which predict deeper extratropical cyclones when baroclinicity is highest. Although the surface baroclinicity peaks during midwinter, and the jet is strongest, eddy kinetic energy (EKE) and baroclinic conversion rates have a midwinter minimum over the North Pacific. This study investigates how the reduction in EKE translates into a reduction in eddy potential vorticity (PV) and heat fluxes via changes in eddy diffusivity. Additionally, it augments previous observations of the midwinter storm-track evolution in both hemispheres using climatologies of tracked surface cyclones. In the North Pacific, the number of surface cyclones is highest during midwinter, while the mean EKE per cyclone and the eddy lifetime are reduced. The midwinter reduction in upper-level eddy activity hence is not associated with a reduction in surface cyclone numbers. North Pacific eddy diffusivities exhibit a midwinter reduction at upper levels, where the Lagrangian decorrelation time is shortest (consistent with reduced eddy lifetimes) and the meridional parcel velocity variance is reduced (consistent with reduced EKE). The resulting midwinter reduction in North Pacific eddy diffusivities translates into an eddy PV flux suppression. In contrast, in the North Atlantic, a milder reduction in the decorrelation time is offset by a maximum in velocity variance, preventing a midwinter diffusivity minimum. The results suggest that a focus on causes of the wintertime evolution of Lagrangian decorrelation times and parcel velocity variance will be fruitful for understanding causes of seasonal storm-track variations

A graphics package for meteorological data, version 1.5

A plotting package has been developed to simplify the task of plotting meteorological data. The calling sequences and examples of high level yet flexible routines which allow contouring, vectors and shading of cylindrical, polar, orthographic and Mollweide (egg) projections are given. Routines are also included for contouring pressure-latitude and pressure-longitude fields with linear or log scales in pressure (interpolation to fixed grid interval is done automatically). Also included is a fairly general line plotting routine. The present version (1.5) produces plots on WMS laser printers and uses graphics primitives from WOLFPLOT

Bridging conflicting ideologies: the origins of American and British occupational therapy.

Occupational therapy practice has bridged two contradictory value systems for more than 100 years. This article describes the origins of practice ideas in both the United States and Britain and demonstrates that founding members of the occupational therapy profession all shared a core of humanistic beliefs while embracing the emerging paradigm of scientific medicine. The result has been an intellectual tension between the biological and the psychosocial aspects of practice. For more than 75 years, occupational therapists struggled to balance the art and science of patient care; recent debates on modalities, practice domains, and research priorities indicate that the unifying core of the profession is occupation that considers a person\u27s mind and body

How occupational therapists teach older patients to use bathing and dressing devices in rehabilitation.

OBJECTIVE: This article describes the methods occupational therapists use to teach bathing and dressing device use to older patients in rehabilitation programs. The relationship of three patient characteristics to five aspects of assistive device instruction was examined. METHOD: The study sample included 86 patients and 19 occupational therapists who provided the assistive device training. Patients were 55 years of age or older and in rehabilitation for an orthopedic deficit, cerebrovascular accident, or lower limb amputation. Therapists recorded information on teaching methods, perceptions of patient knowledge, and expectations for future device use after each treatment session. RESULTS: Patients received an average of three dressing and two bathing devices for home use. Therapists devoted an average of two and a half sessions (10 min average duration) to teach dressing device use and an average of one session (9 min average duration) to teach bathing device use. Teaching occurred mostly in the clinic setting through oral instruction and demonstration. At discharge, patients who evaluated devices positively and were evaluated as having a positive affect were perceived by the therapists as having greater knowledge of device use. More time was spent teaching those patients with lower Functional Independence Measure scores, less positive evaluations of devices, and lower affect scores. Family caregivers were involved in one or more dressing sessions for 26% of patients and one or more bathing sessions for 36% of patients. CONCLUSION: Assistive device training in rehabilitation centers consists largely of simulated sessions in the occupational therapy clinic, and patients in the study described the instruction they received as satisfactory. More research is needed to study the long-term effectiveness of assistive device training after patients return home

Mentorship experiences in a group of occupational therapy leaders.

OBJECTIVES: The development of occupational therapy leaders is a long-held goal of many members of the American Occupational Therapy Association and of state associations. The initiation of mentor programs is a common means to accomplish this goal. These programs take time and effort, and, although occupational therapists have described how mentorship programs work in the literature, there are few articles that describe the actual mentorship experiences of occupational therapy leaders. METHOD: To study the experiences of elected occupational therapy leaders, a 30-item questionnaire was distributed at the annual meeting of the Committee of State Association Presidents and completed by 53 respondents. Results were analyzed, and cross tabulations were run between selected items. RESULTS: Respondents were frequently exposed to role models, were assisted by sponsors, were mentored by other occupational therapists, and served as mentors themselves. There was little evidence that the respondents were mentored by high-powered individuals who helped launch their careers. CONCLUSION: More than half of the respondents were mentored by other occupational therapists, and only 29% of the respondents reported that they surpassed the status and position of their mentors. Plans to initiate mentorship programs should include activities that promote powerful leaders who move beyond the status and position of their mentors, so that occupational therapists can represent the interests of the profession to others

A curriculum based on systems theory.

This paper describes an entry-level curriculum based on systems theory that was designed to promote integrated thinking and a shared image of practice among all of the members of an educational community that included students, faculty, and clinicians. Initiated in 1983, the program integrates occupational therapy theory, critical thinking, and knowledge about person-environmental transactions with traditional medical, biological, psychological, and sociological course work to create a unique educational experience. The curriculum model is based on a spiral learning process that encourages integrated thinking. Furthermore, all concepts are systematically tied to the occupation core, the central theme of the program. Fieldwork is used to reinforce ideas presented in the classroom and features discrete learning experiences where students demonstrate their integration of knowledge and skills. In an evaluation of the program, responses from 78 clinician, 51 alumni, and 132 student questionnaires; feedback from 132 fieldwork supervisors; and longitudinal data from 33 alumni confirmed that graduates are critical thinkers who appreciate the diverse needs of clients while demonstrating an appreciation for the curative effect of meaningful, goal-directed activities

Taphonomy and palaeoecology of the green Devonian gypidulid brachiopods from the Aferdou El Mrakib, eastern Anti-Atlas, Morocco

On Aferdou El Mrakib, a large reef mound in the Maïder region (Anti-Atlas, Morocco), thick-shelled gypidulids of two genera are locally very abundant. Like Stringocephalus in the shallow water limestone formations in Germany, these Moroccan brachiopods of the genera Devonogypa and Ivdelinia often display greenish shells. By analysing these shells by EDX, it turned out that the colour was possibly caused by impurities of Fe2+-ions. The concentration varies, indicating that the colour is less dependent on the concentration than on shell thickness, because only the thickest parts of the shells appear green and thin-shelled forms never display the green colour. There is also some indication that the Fe content increases towards deeper shell layers (further away from the surface). In addition, we examined the quality and spatial distribution of sublethal injuries in over 200 specimens of Devonogypa and Ivdelinia. Shape, spatial distribution on the shells, and abundance of the sublethal injuries support the hypotheses that (1) the injuries had several causes, (2) some of these were inflicted by predators, probably cephalopods, and (3) many fractures and deformations might have been caused by the brachiopod shells hitting each other in dense populations in agitated water. The existence of dense clusters, built by the association of members of both genera or of only one taxon, is corroborated by the patchy occurrence of these brachiopod