One of the major needs for medical schools and health systems in less affluent countries is system strengthening through the training and development of faculty, doctors, nurses, and other skilled health care workers. Partnering with medical schools in more affluent countries such as the United States is one potential approach for medical schools in underresourced areas, such as Sub-Saharan Africa. Most commonly, these partnerships have focused on research agendas or limited educational exchanges. In this perspective, the authors present an approach to strengthening collaborative relationships between three medical schools in the United States and four in Sub-Saharan Africa. The approach is explicitly focused on achieving partnerships that enable institutions to improve care. It developed from an initiative to fund partnerships or "collaboratives" that address 10 key learning questions determined to be central to focusing efforts on strengthening education systems and, in turn, improving health in Sub-Saharan Africa. The leaders of the schools involved in these partnerships met multiple times across three years to discuss how their collaboratives could address the ten learning questions including what is the best approach and what are the key ingredients for creating effective, multidimensional collaborations between academic institutions in the North and institutions in Sub-Saharan Africa. Collaboratively, they defined a framework of evidence that can be used for evaluating their current initiatives and, potentially, for structuring future partnerships.
Nitric oxide (NO) is an important systemic and pulmonary arterial vasodilator. The conversion of nitrite (derived from dietary nitrate) to nitric oxide can occur independent of nitric oxide synthase (Lundberg & Govoni 2004) in a process that is upregulated in hypoxic conditions (Lundberg et al., 2008). Since patients with chronic obstructive pulmonary disease (COPD) commonly suffer hypoxaemia during exercise, we hypothesized that dietary nitrate supplementation might acutely improve exercise capacity in hypoxic COPD patients through enhanced production of NO.We compared the acute effect of beetroot juice (containing14 mmol of nitrate) on exercise capacity and arterial systolic blood pressure in COPD patients compared to a matched placebo drink (containing less than 0.5 mmol of dietary nitrate).Twelve subjects (6 male) with COPD were recruited. Resting blood pressure was assessed in duplicate (manual sphygmomanometer). Heart rate and arterial oxygen concentration (pulse oximetry) as well as self-reported breathlessness (Borg dyspnea scale) were assessed pre-and post-incremental shuttle walk test. Subjects were then randomized to drink beetroot juice or a matched placebo and the protocol was repeated 3 hours later. The 3h rest period was to allow for sufficient recovery from baseline testing and has been found to correspond with peak plasma nitrite concentrations following oral consumption of dietary nitrate (Webb et al., 2008). After a 7-day washout period, the protocol was repeated with the crossover beverage.There were no significant differences in heart rate, arterial oxygen concentrations, or breathlessness at any time point. However, COPD subjects who took dietary nitrate walked significantly further than when they took placebo ( + 23 vs. -13 metres; p < 0.01) and had a reduction in both systolic blood pressure ( -13 vs. 0 mmHg; p < 0.05) and diastolic blood pressure ( -3.2 vs. + 7.8 mmHg; p < 0.05).Acute consumption of dietary nitrate can improve exercise tolerance and lower blood pressure in COPD patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.