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Background:
Malawi faces a severe lack of health workers. Despite initiatives to address this problem, a critical shortage of health care staff remains. This lack challenges the education and training of junior medical staff, especially medical interns in their final and crucial training year before they independently work as medical doctors.
Project description:
We have introduced an e-learning platform in the medical department of the Kamuzu Central Hospital (KCH) in Malawi. With the support of computer-assisted instruction, we aimed to improve the quality of medical training and education, as well as access to current medical materials, in particular for interns.
Method:
From March to April 2012, we conducted a qualitative evaluation to assess relevance and appropriateness of the e-learning platform. Data was collected via face-to-face interviews, a guided group discussion and a checklist based observation log. Evaluation data was recorded and coded using content analysis, interviewees were chosen via purposive sampling.
Results:
E-learning proved to be technically feasible in this setting. Users considered the e-learning platform to be relevant and appropriate. Concerns were raised about sustainability, accessibility and technical infrastructure, as well as limited involvement and responsibilities of Malawian partners. Interest in e-learning was high, yet, awareness of and knowledge about the e-learning platform among potential users was low. Evaluation results indicated that further adaptions to local needs are necessary to increase usage and accessibility.
Conclusions:
Interview results and our project experiences showed that, in the given setting, e-learning requires commitment from local stakeholders, adequate technical infrastructure, identification and assignation of responsibilities, as well as specific adaption to local needs.
West African torrent-frogs of the genus Odontobatrachus currently belong to a single species: Odontobatrachus natator (Boulenger, 1905). Recently, molecular results and biogeographic separation led to the recognition of five Operational Taxonomic Units (OTUs) thus identifying a species-complex. Based on these insights, morphological analyses on more than 150 adult specimens, covering the entire distribution of the family and all OTUs, were carried out. Despite strong morphological congruence, combinations of morphological characters made the differentiation of OTUs successful and allowed the recognition of five distinct species: Odontobatrachus natator, and four species new to science: Odontobatrachus arndti sp. n., O. fouta sp. n., O. smithi sp. n. and O. ziama sp. n. All species occur in parapatry: Odontobatrachus natator is known from western Guinea to eastern Liberia, O. ziama sp. n. from eastern Guinea, O. smithi sp. n. and O. fouta sp. n. from western Guinea, O. arndti sp. n. from the border triangle Guinea-Liberia-Cote d'Ivoire. In addition, for the first time the advertisement call of a West African torrent-frog (O. arndti sp. n.) is described.
Starting in the late 1990s ionic liquids (ILs) gained momentum both in academia as well as industry. ILs are defined as organic salts with a melting point below 100 °C. Active pharmaceutical ingredients (APIs) may be transferred into ILs by creating salts with a bulky counterion with a soft electron density. ILs have demonstrated the potential to tune important pharmaceutical features such as the solubility and the dissolution rate, particularly addressing the challenge of poor water soluble drugs (PWSD). Due to the tunability of ILs, modification of physico-chemical properties of APIs may be envisioned without any modifications of the chemical structure.
In the first chapter the potential as well as the limitation of ILs are discussed. The chapter commences with an overview of preparation and characterization of API-ILs. Moreover, examples for pharmaceutical parameters are presented which may be affected by IL formation, including the dissolution rate, kinetic solubility or hygroscopicity as well as biopharmaceutical performance and toxicology. The impact of IL formation on those pharmaceutically relevant features is highlighted, resulting in a blueprint for a novel formulation concept to overcome PWSD challenges without the need for structural changes of the API.
Within the second chapter the IL concept is detailed for one specific API - counterion combination. A poorly water soluble acidic API against migraine attacks was transformed into an IL in an effort to minimize the time to maximum plasma concentration (tmax) and optimize the overall bioavailability. These studies were conducted in parallel to a prodrug of the API for comparison of the IL strategy versus a strategy involving modification of the API’s structure. A significantly longer duration of API supersaturation and a 700 fold faster dissolution rate of the IL in comparison to the free acid were obtained and the underlying mechanism was elucidated. The transepithelial absorption was determined using Caco-2 cell layers. For the IL about 3 times more substance was transported in comparison to the prodrug when substances were applied as suspensions, despite the higher permeability of the prodrug, as increased solubility of the IL exceeded this effect. Cytotoxicity of the counterion was assessed in hepatic, renal and macrophage cell lines, respectively, and IC50 values were in the upper µM / lower mM range. The outcome of the study suggested the IL approach instrumental for tuning biopharmaceutical properties, without structural changes of the API as required for preparation of prodrugs. Thus the toolbox for formulation strategies of poorly water soluble drugs could be extended by an efficient concept.
The third chapter focuses on the effect of different counterions on the physico-chemical properties of an API-IL, in particular to overcome the challenge of poor water solubility. Therefore, the same poorly water soluble acidic API against migraine attacks mentioned above was combined with 36 counterions resulting in ILs and low lattice enthalpy salts (LLES). Depending on the counterions, different dissolution rates, durations of supersaturation and hygroscopicities were obtained and release profiles could be tailored from immediate to sustained release. Besides, in vitro the cytotoxicity of the counterions was assessed in three cell lines. Using molecular descriptors such as the number of hydrophobic atoms, the graph theoretical diameter and the number of positive charges of the counterion, the dissolution rate, supersaturation and hygroscopicity as well as the cytotoxicity of counterions could be adequately modeled, rendering it possible to predict properties of new LLESs.
Within the forth chapter different poorly water soluble APIs were combined with the counterion tetrabutylphosphonium (TBP) studying the impact on the pharmaceutical and physical properties of the APIs. TBP-ILs and low lattice enthalpy salts were prepared of the acidic APIs Diclofenac, Ibuprofen, Ketoprofen, Naproxen, Sulfadiazine, Sulfamethoxazole and Tolbutamide. NMR and IR spectroscopy, DSC, XRPD, DVS and dissolution rate measurements, release profiles and saturation concentration measurements were used to characterize the free acids and TBP salts as compared to the corresponding sodium salts. The TBP salts as compared to the free acids displayed lower melting points and glass transition temperatures and up to 1000 times higher dissolution rates. The increase in the dissolution rate directly correlated with the salts’ hygroscopicity, an aspect which is critically discussed in terms of pharmaceutical translation challenges. In summary TBP ILs of solid salts were proved instrumental to approach the challenge of poor water solubility. The outcome profiled tailor-made counterions as a powerful formulation strategy to address poor water solubility, hence bioavailability and ultimately therapeutic potential of challenging APIs.
In summary, a plethora of ILs and LLESs were prepared by combination of different acidic APIs and counterions. The IL and LLESs concept was compared to conventional salt and prodrug strategies. By choice of the counterion, biopharmaceutical relevant parameters were deliberately modified and release profiles were tuned ranging from immediate to prolonged release. The impact of distinct structural counterion features controlling the dissolution, supersaturation, hygroscopicity and counterion cytotoxicity were identified, correlations were presented and predictive models were built. ILs and LLESs could be proven to be a powerful concept for the formulation of poorly water soluble acidic APIs.
Names of, for instance, children or companies are often chosen very carefully. They should sound and feel good. Therefore, many companies try to choose artificially created names that can easily be pronounced in various languages. A wide range of psychological research has demonstrated that easy processing (high processing fluency) is intrinsically experienced as positive. Due to this positive feeling, easy processing can have profound influences on preferences for names.
Topolinski, Maschmann, Pecher, and Winkielman (2014) have introduced a different mechanism that influences the perception of words. Across several experiments they found that words featuring consonantal inward wanderings (inward words) were preferred over words featuring consonantal outward wanderings (outward words). They argued that this was due to the fact that approach and avoidance motivations are activated by articulating inward and outward words, because the pronunciation resembles approach and avoidance behaviors of swallowing and spitting, respectively. They suggested this close link as an underlying mechanism for the so-called in-out effect, but did not test this assumption directly.
In the current work, I tested an alternative fluency account of the in-out effect. Specifically, I hypothesized that processing fluency might play a critical role instead of motivational states of approach and avoidance being necessarily activated.
In Chapter 1, I introduce the general topic of my dissertation, followed by a detailed introduction of the research area of approach and avoidance motivations in Chapter 2. In Chapter 3, I narrow the topic down to orally induced approach and avoidance motivations, which is the main topic of my dissertation. In Chapter 4, I introduce the research area of ecological influences on psychological processes. This chapter builds the base for the idea that human language might serve as a source of processing fluency in the in-out effect. In the following Chapter 5, I elaborate the research area of processing fluency, for which I examined whether it plays a role in the in-out effect.
After an overview of my empirical work in Chapter 6, the empirical part starts with Study 1a and Study 1b (Chapter 7) that aimed to show that two languages (Eng. & Ger.) in which the in-out effect has originally been found might feature a source of higher processing fluency for inward over outward words. The results showed that higher frequencies of inward dynamics compared to outward dynamics were found in both languages. This can lead to higher pronunciation fluency for inward compared to outward words which might in turn lay the ground for higher preferences found for inward over outward words.
In Chapter 8, the assumption that inward compared to outward dynamics might be more efficient to process was tested directly in experiments that examined objective as well as subjective processing fluency of artificially constructed non-words featuring pure inward or outward dynamics. Studies 2a-4b found an objective as well as subjective processing advantage for inward over outward words.
In Chapter 9, the causal role of objective and subjective pronunciation fluency in the in-out effect was examined. In Study 5 mediational analyses on item-level and across studies were conducted using objective and subjective fluency as possible mediating variables. In Study 6 mediation analyses were conducted with data on subject- and trial-level from a within-subject design. Overall, the data of the item-based, subject-based and trial-based mediation analyses provide rather mixed results. Therefore, an experimental manipulation of fluency was implemented in the last two studies.
In Chapter 10, Study 7 and Study 8 demonstrate that manipulating fluency experimentally does indeed modulate the attitudinal impact of consonantal articulation direction. Articulation ease was induced by letting participants train inward or outward kinematics before the actual evaluation phase. Additionally, the simulation training was intensified in Study 8 in order to examine whether a stronger modulation of the in-out effect could be found. Training outward words led to an attenuation and, after more extensive training, even to a reversal of the in-out effect, whereas training inward words led to an enhancement of the in-out effect. This hints at my overall hypothesis that the explicit preferences of inward and outward words are, at least partially, driven by processing fluency.
Almost all studies of my dissertation, except for one analysis of the item-based mediation study, speak in favor of the hypothesis that inward words compared to outward words are objectively and subjectively easier to articulate. This possibly contributes partially to a higher preference of inward over outward words. The results are discussed in Chapter 11 with respect to processing fluency and to the role of language as an ecological factor. Finally, future research ideas are elaborated.
The active place avoidance task is a dry-arena task used to assess spatial navigation and memory in rodents. In this task, a subject is put on a rotating circular arena and avoids an invisible sector that is stable in relation to the room. Rotation of the arena means that the subject's avoidancemust be active, otherwise the subject will be moved in the to-be-avoided sector by the rotation of the arena and a slight electric shock will be administered. The present experiment explored the effect of variable arena rotation speed on the ability to avoid the to-be-avoided sector. Subjects in a group with variable arena rotation speed learned to avoid the sector with the same speed and attained the same avoidance ability as rats in a group with a stable arena rotation speed. Only a slight difference in preferred position within the room was found between the two groups. No difference was found between the two groups in the dark phase, where subjects could not use orientation cues in the room. Only one rat was able to learn the avoidance of the to-be-avoided sector in this phase. The results of the experiment suggest that idiothetic orientation and interval timing are not crucial for learning avoidance of the to-be-avoided sector. However, idiothetic orientation might be sufficient for avoiding the sector in the dark.
Magnetic resonance imaging is derogated by the presence of metal implants and image quality is impaired. Artifacts are categorized according to their sources, the differences in susceptibility between metal and tissue and the modulation of the magnetic radiofrequency (RF) transmit field. Generally, these artifacts are intensified at higher field strength. The purpose of this work is to analyze the efficiency of current methods used for metal artifact reduction at 3T and to investigate improvements. The impact of high-bandwidth RF pulses on susceptibility-induced artifacts is tested. In addition, the benefit of a two-channel transmit system with respect to shading close to total hip replacements and other elongated metal structures in parallel to the magnetic field is analyzed.
Local transmit/receive coils feature a higher peak B1 amplitude than conventional body coils and thus enable high-bandwidth RF pulses. Susceptibility-induced through-plane distortion relates reciprocally to the RF bandwidth, which is evaluated in vitro for a total knee arthroplasty. Clinically relevant sequences (TSE and SEMAC) with conventional and high RF pulse bandwidths and different contrasts are tested on eight patients with different types of knee implants. Distortion is rated by two radiologists. An additional analysis assesses the capability of a local spine transmit coil. Furthermore, B1 effects close to elongated metal structures are described by an analytical model comprising a water cylinder and a metal rod, which is verified numerically and experimentally. The dependence of the optimal polarization of the transmit B1 field, creating minimum shading, on the position of the metal is analyzed. In addition, the optimal polarization is determined for two patients; its benefit compared to circular polarization is assessed.
Phantom experiments confirm the relation of the RF bandwidth and the through-plane distortion, which can be reduced by up to 79% by exploitation of a commercial local transmit/receive knee coil at 3T. On average, artifacts are rated “hardly visible” for patients with joint arthroplasties, when high-bandwidth RF pulses and SEMAC are used, and for patients with titanium fixtures, when high-bandwidth RF pulses are used in combination with TSE. The benefits of the local spine transmit coil are less compared to the knee coil, but enable a bandwidth 3.9 times as high as the body coil. The modulation of B1 due to metal is approximated well by the model presented and the position of the metal has strong influence on this effect. The optimal polarization can mitigate shading substantially.
In conclusion, through-plane distortion and related artifacts can be reduced significantly by the application of high-bandwidth RF pulses by local transmit coils at 3T. Parallel transmission offers an option to substantially reduce shading close to long metal structures aligned with the magnetic field. Effective techniques dedicated for metal implant imaging at 3T are introduced in this work.
The worldwide demand for food has been increasing due to the rapidly growing global population, and agricultural lands have increased in extent to produce more food crops. The pattern of cropland varies among different regions depending on the traditional knowledge of farmers and availability of uncultivated land. Satellite images can be used to map cropland in open areas but have limitations for detecting undergrowth inside forests. Classification results are often biased and need to be supplemented with field observations. Undercover cropland inside forests in the Bale Mountains of Ethiopia was assessed using field observed percentage cover of land use/land cover classes, and topographic and location parameters. The most influential factors were identified using Boosted Regression Trees and used to map undercover cropland area. Elevation, slope, easterly aspect, distance to settlements, and distance to national park were found to be the most influential factors determining undercover cropland area. When there is very high demand for growing food crops, constrained under restricted rights for clearing forest, cultivation could take place within forests as an undercover. Further research on the impact of undercover cropland on ecosystem services and challenges in sustainable management is thus essential.
Environmental interlinked problems such as human-induced land cover change, water scarcity, loss in soil fertility, and anthropogenic climate change are expected to affect the viability of agriculture and increase food insecurity in many developing countries. Climate change is certainly the most serious of these challenges for the twenty-first century. The poorest regions of the world – tropical West Africa included – are the most vulnerable due to their high dependence on climate and weather sensitive activities such as agriculture, and the widespread poverty that limits the institutional and economic capacities to adapt to the new stresses brought about by climate change. Climate change is already acting negatively on the poor smallholders of tropical West Africa whose livelihoods dependent mainly on rain-fed agriculture that remains the cornerstone of the economy in the region. Adaptation of the agricultural systems to climate change effects is, therefore, crucial to secure the livelihoods of these rural communities. Since information is a key for decision-making, it is important to provide well-founded information on the magnitude of the impacts in order to design appropriate and sustainable adaptation strategies.
Considering the case of agricultural production in the Republic of Benin, this study aims at using large-scale climatic predictors to assess the potential impacts of past and future climate change on agricultural productivity at a country scale in West Africa. Climate signals from large-scale circulation were used because state-of-the art regional climate models (RCM) still do not perfectly resolve synoptic and mesoscale convective processes. It was hypothesised that in rain-fed systems with low investments in agricultural inputs, yield variations are widely governed by climatic factors. Starting with pineapple, a perennial fruit crops, the study further considered some annual crops such as cotton in the group of fibre crops, maize, sorghum and rice in the group of cereals, cowpeas and groundnuts belonging to the legume crops, and cassava and yams which are root and tuber crops. Thus the selected crops represented the three known groups of photosynthetic pathways (i.e. CAM, C3, and C4 plants).
In the study, use was made of the historical agricultural yield statistics for the Republic of Benin, observed precipitation and mean near-surface air temperature data from the Climatic Research Unit (CRU TS 3.1) and the corresponding variables simulated by the regional climate model (RCM) REMO. REMO RCM was driven at its boundaries by the global climate model ECHAM 5. Simulations with different greenhouse gas concentrations (SRES-A1B and B1 emission scenarios) and transient land cover change scenarios for present-day and future conditions were considered. The CRU data were submitted to empirical orthogonal functions analysis over the north hemispheric part of Africa to obtain large-scale observed climate predictors and associated consistent variability modes. REMO RCM data for the same region were projected on the derived climate patterns to get simulated climate predictors. By means of cross-validated Model Output Statistics (MOS) approach combined with Bayesian model averaging (BMA) techniques, the observed climate predictors and the crop predictand were further on used to derive robust statistical relationships. The robust statistical crop models perform well with high goodness-of-fit coefficients (e.g. for all combined crop models: 0.49 ≤ R2 ≤ 0.99; 0.28 ≤ Brier-Skill-Score ≤ 0.90).
Provided that REMO RCM captures the main features of the real African climate system and thus is able to reproduce its inter-annual variability, the time-independent statistical transfer functions were then used to translate future climate change signal from the simulated climate predictors into attainable crop yields/crop yield changes. The results confirm that precipitation and air temperature governed agricultural production in Benin in general, and particularly, pineapple yield variations are mainly influenced by temperature. Furthermore, the projected yield changes under future anthropogenic climate change during the first-half of the 21st century amount up to -12.5% for both maize and groundnuts, and -11%, -29%, -33% for pineapple, cassava, and cowpeas respectively. Meanwhile yield gain of up to +10% for sorghum and yams, +24% for cotton, and +39% for rice are expected. Over the time period 2001 – 2050, on average the future yield changes range between -3% and -13% under REMO SRES–B1 (GHG)+LCC, -2% and -11% under REMO SRES–A1B (GHG only),and -3% and -14% under REMO SRES–A1B (GHG)+LCC for pineapple, maize, sorghum, groundnuts, cowpeas and cassava. In the meantime for yams, cotton and rice, the average yield gains lie in interval of about +2% to +7% under REMO SRES–B1 (GHG)+LCC, +0.1% and +12% under REMO SRES–A1B (GHG only), and +3% and +10% under REMO SRES–A1B (GHG)+LCC. For sorghum, although the long-term average future yield depicts a reduction there are tendencies towards increasing yields in the future. The results also reveal that the increases in mean air temperature more than the changes in precipitation patterns are responsible for the projected yield changes. As well the results suggest that the reductions in pineapple yields cannot be attributed to the land cover/land use changes across sub-Saharan Africa. The production of groundnuts and in particular yams and cotton will profit from the on-going land use/land cover changes while the other crops will face detrimental effects.
Henceforth, policymakers should take effective measures to limit the on-going land degradation processes and all other anthropogenic actions responsible for temperature increase. Biotechnological improvement of the cultivated crop varieties towards development of set of seed varieties adapted to hotter and dry conditions should be included in the breeding pipeline programs. Amongst other solutions, application of appropriate climate-smart agricultural practices and conservation agriculture are also required to offset the negative impacts of climate change in agriculture.
Extreme value theory aims at modeling extreme but rare events from a probabilistic point of view. It is well-known that so-called generalized Pareto distributions, which are briefly reviewed in Chapter 1, are the only reasonable probability distributions suited for modeling observations above a high threshold, such as waves exceeding the height of a certain dike, earthquakes having at least a certain intensity, and, after applying a simple transformation, share prices falling below some low threshold. However, there are cases for which a generalized Pareto model might fail. Therefore, Chapter 2 derives certain neighborhoods of a generalized Pareto distribution and provides several statistical tests for these neighborhoods, where the cases of observing finite dimensional data and of observing continuous functions on [0,1] are considered. By using a notation based on so-called D-norms it is shown that these tests consistently link both frameworks, the finite dimensional and the functional one. Since the derivation of the asymptotic distributions of the test statistics requires certain technical restrictions, Chapter 3 analyzes these assumptions in more detail. It provides in particular some examples of distributions that satisfy the null hypothesis and of those that do not. Since continuous copula processes are crucial tools for the functional versions of the proposed tests, it is also discussed whether those copula processes actually exist for a given set of data. Moreover, some practical advice is given how to choose the free parameters incorporated in the test statistics. Finally, a simulation study in Chapter 4 compares the in total three different test statistics with another test found in the literature that has a similar null hypothesis. This thesis ends with a short summary of the results and an outlook to further open questions.
In 2013, three hundred years had passed since the foundation of the Real Academia Española (RAE). The celebrations accompanying this anniversary were extended across the year and came to a closure with the publication of the 23rd edition of the Diccionario de la lengua española in 2014. Spanish media followed the above-mentioned festivities with a detailed coverage. The purpose of this article is to study the image of the RAE conveyed through the media and the Internet, which can be subsumed under the three terms ‘diverse, democratic and modern’. This form of representation is put into a broader context by considering the linguistic politics pursued by the RAE and the Asociación de Academias de la Lengua Española (ASALE) under the keyword of panhispanism. Finally, a closer look is taken at El buen uso del español, a student manual published by the RAE and the ASALE in 2013, in relation to panhispanism and prescriptivism.